Gastric Ectopic Pancreas - A Case Report

The ectopic pancreas is a rare embryological abnormality not in association with others. The stomach and duodenum are the most common organs involved. Symptoms are nonspecific. Patients may complain of dyspepsia, abdominal pain


Introduction
The incidence of the ectopic pancreas is 0.6-13%, according to autoptic findings [1].In 90 % of the cases, it is found in the submucosal and muscularis propria of the gastrointestinal tract, especially in the stomach and the duodenum

Case Report
A 23-year-old woman was admitted to the emergency department for repeated episodes of vomiting, dyspepsia, and abdominal pain.She had a family history of gastric cancer.Abdominal examination was unremarkable except for epigastric tenderness; no masses were appreciated.Her blood tests were routine.Her account shows an esophagogastroduodenoscopy (EGD) showed a mucosal bulging and mild antral gastritis (figure 1a).For a better investigation, the patient underwent an abdominal computed tomography (CT scan) that showed 22x10x10mm submucosal lesion along the lesser curvature in the stomach.No adjacent regional lymphadenopathy was noted.According to her symptoms, her personal history, and the radiological findings, surgical resection was performed.At surgery, a mass was identified in the proximal body with overlying mucosa measuring 4.5x2.3x1.3cmwithout serosal invasion.The specimen was sent for histopathological examination.Her all-baseline profile was within normal limits.The postoperative course and follow-up at one month remained uneventful.

Abstract
The ectopic pancreas is a rare embryological abnormality not in association with others.The stomach and duodenum are the most common organs involved.Symptoms are nonspecific.Patients may complain of dyspepsia, abdominal pain, or intestinal obstruction.Diagnosis can be very challenging due to the rarity of the disease and the absence of specific symptoms and radiological findings.Here we report a case of Heterotopic pancreas in gastric tissue in a 23-year-old woman admitted to the emergency department due to acute upper gastrointestinal symptoms.Endoscopic ultrasonography revealed submucosal gastric lesions.The patient underwent abdominal computed tomography that showed gastric mass originating along the lesser curvature of the stomach.According to the patient's symptoms, family history, and radiological findings, the patient was scheduled for surgical resection.In this case, the ectopic gastric pancreas was found on routine histopathological examination.Clinical presentation of the ectopic pancreas can be challenging, especially in an emergency.Diagnostic-therapeutic laparoscopy should be considered in symptomatic patients.

Pathologic Findings
A gross examination of the resected gastric specimen revealed tissue structure with overlying mucosa measuring 4.5x2.3x1.3cm.The cut section of the tissue structure showed a grey-brown area measuring 2x2x0.7cm.
A microscopic examination from the resected specimen showed gastric mucosa with underlying submucosa, muscularis propria, and subserosa showing normal pancreatic ducts, acini, and islet cells.
There was no evidence of any neoplastic pathology in the submitted biopsy (Figures 2a and 2b).1.3-1.4cm2,3.In our case, the endoscopic study showed a mucosa bulging.Moreover, the patient was symptomatic, and a CT scan showed a gastric mass originating along the lesser curvature.
Therefore, the patient was scheduled for surgical resection.

Conclusion
Gastric ectopic pancreas clinical presentation is heterogeneous and mimics different pathologies.This way, diagnosis is not easy, especially in an emergency.EUS is the preferred examination for submucosal lesions, but it cannot accurately assess the diagnosis.
Hence, a diagnostic-therapeutic laparoscopy can be considered in symptomatic patients with large-size lesions or findings suspected of malignancy.

[ 2 ]
. Usually, the disease is asymptomatic, and most cases are detected incidentally [3].In rare cases, it can present acutely with abdominal pain, vomiting, bowel obstruction, or thoracic pain [2].Endoscopic ultrasonography (EUS) is considered the most appropriate diagnostic tool for submucosal gastric lesions.However, it cannot assess the diagnosis with absolute certainty [3].Accordingly, surgery can be considered for a definitive diagnosis and treatment in symptomatic patients with inconclusive endoscopic and radiological findings.

Keywords:Figure 1A :
Figure 1A: Endoscopic image.Esophagogastroduodenoscopy revealed a submucosal bulge with a diameter of approximately 22x10x10mm in the lesser curvature of the gastric wall.