Heterotopic Pancreatitis: Gastric Outlet Obstruction due to an Intramural Pseudocyst and Hamartoma

Abstract

Heterotopic pancreas, usually a silent gastrointestinal malformation, may become clinically evident when complicated by chronic inflammation. We report a case of pancreatitis and extensive pseudocyst formation in the gastric antrum, which caused gastric outlet obstruction. The diagnosis was obscured by a history of emesis during pregnancy and a previously resected gastric polyp. The nature of the obstructive lesion was not diagnosed preoperatively in spite of endosonographic evaluation. Intraoperatively, a cystic tumor of the stomach wall was found, the lesion was excised, and a pyloroplasty was performed to close the excision site. Histology revealed heterotopic pancreatic tissue with chronic inflammation, fibrosis and pseudocyst formation and adjacent to this lesion a myoglandular hamartoma. The patient is symptom-free two years after surgery and no recurrence was found. The nature of heterotopic pancreatic tissue, its diagnosis and management are discussed.

Zusammenfassung

Heterotopes Pankreasgewebe, normalerweise ein klinisch inapparenter Zufallsbefund, gewinnt Relevanz bei chronisch entzündlichen Veränderungen. Wir berichten von einem Fall einer intramuralen chronischen Pankreatitis mit Pseudozystenbildung im Antrum des Magens, welche die Symptomatik einer massiven Magenausgangsstenose verursachte. In unserem Fall wurde die Diagnose durch die Vorgeschichte einer Schwangerschaft mit Hyperemesis und eines Magenpolypen verschleiert. Die Pseudozyste wurde präoperativ trotz endosonographischer Untersuchung nicht diagnostiziert. Intraoperativ fiel ein zystischer Tumor der Magenwand auf, der exzidiert wurde. Der Magenwanddefekt wurde mittels Pyloroplastik verschlossen. Histologisch fanden sich in der Muscularis propria heterotope Gewebeinseln mit Pankreasgewebe mit chronisch granulierender Entzündung und herdförmiger Pseudozystenbildung und in der Nachbarschaft ein myoglanduläres Hamartom. Die Patientin ist postoperativ seit zwei Jahren symptom- und rezidivfrei. Natur, Diagnose und Management des heterotopen Pankreasgewebes werden besprochen.

Key words

Heterotopic Pancreas - Gastric Outlet Obstruction - Pancreatic Pseudocyst

Schlüsselwörter

Heterotopes Pankreas - Magenausgangsstenose - Pankreaspseudozyste

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