Abstract
Background
Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature.
Methods
We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature.
Results
1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis.
Conclusion
The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment.
Disclosure
All authors have declared no conflicts of interest.
A Triad of Congenital Diaphragmatic Hernia, Meckel’s Diverticulum, and Heterotopic Pancreas