Bleeding duodenal ectopic pancreas: laparoscopic case report

Heterotopic pancreas (HP) is a rare congenital anomaly characterized by pancreatic tissue located outside the normal pancreas without anatomical or vascular continuity. While often asymptomatic and detected incidentally, it may cause non-specific symptoms depending on its size and location. All benign and malignant pancreatic pathologies may develop in HP, and rare presentations such as gastrointestinal (GI) bleeding can also occur. Due to the diagnostic challenge, particularly in GI bleeding cases, it remains clinically significant.

A 33-year-old woman with no known comorbidities presented with epigastric pain and rectal bleeding. Endoscopic evaluation revealed a 2.5 cm submucosal lesion in the third portion of the duodenum. Laparoscopic wedge resection was performed, and the final histopathological examination confirmed heterotopic pancreatic tissue. The patient was discharged without complications on postoperative day 4. Postoperatively, the patient had complete resolution of symptoms.

Duodenal HP is often difficult to diagnose preoperatively due to its submucosal location and non-specific imaging features. Endoscopic biopsy may fail to provide conclusive histology, thus necessitating surgical intervention. Laparoscopic wedge resection offers a minimally invasive, effective, and safe treatment modality that enables both definitive diagnosis and therapy.

Duodenal heterotopic pancreas is a rare but important differential in GI bleeding. Laparoscopic wedge resection offers a safe and definitive therapeutic approach, especially when histopathological diagnosis cannot be achieved preoperatively.