Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians’ knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.

Single-site laparoscopic treatment of pathological intussusception secondary to heterotopic pancreas in an 11-month old infant

Background: Intussusception in children is mostly idiopathic, while intestinal intussusception in infancy is uncommon. Specially, intussusception caused by isolated ileal heterotopic pancreas, the abnormal localization of a well-differentiated pancreatic tissue in the ileal serosa, is relatively rare. Early recurrence of intussusception would suggest the presence of pathological lead point and the possibility of surgical exploration. Case presentation: An 11-month-old boy, diagnosed with recurrent intussusception caused by ileal heterotopic pancreas, was admitted to our hospital. After admission, the baby was resuscitated with normal saline and received air edema twice, but both failed. Given the presence of pathological intussusception, the boy was sent to operating theater and received a single-site laparoscopically assisted surgery. The patient recovered successfully and got a satisfactory cosmetic result.Conclusions: Due to its minimally invasive and diagnostic advantages, laparoscopy proves to be a safe and attractive alternative, especially for emergency patient with stable hemodynamics but no definite radiological diagnosis. Meanwhile, we emphasize the importance of paying essential attention to the condition that recurrent intussusception of extreme age should always be taken into consideration.