Symptomatic pyloric pancreatic heterotopia: report of three cases and review of the literature.

BACKGROUND: Pancreatic heterotopia is a relatively common congenital anomaly which sometimes becomes symptomatic and mimics other upper gastrointestinal tract (GIT) pathologies. It is the presence of abnormally located pancreatic glandular tissue at sites with no structural or vascular contact with the main pancreas. It most often occurs in the proximal gastrointestinal tract. The hallmark of diagnosis is the presence of pancreatic tissue within another, anatomically different organ. CASE REPORT: We report three patients, I, II, and III, 48, 86, and 33 years of age, respectively, surgically treated for symptomatic heterotopic pancreas in the pylorus. A review of the literature on this pathology is hereby presented. Patients I and II had uneventful postoperative recovery, while patient III developed postoperative intra-abdominal sepsis due to leakage from the gastric suture line, which was treated with further surgery. Histology confirmed pancreatic heterotopia in all cases. All patients made full recovery and follow-up endoscopy showed no residual disease.
CONCLUSIONS: Most pancreatic heterotopias are asymptomatic and require no treatment. This entity is extremely difficult to diagnose preoperatively as the cause of upper gastrointestinal tract symptoms and therefore requires a high index of suspicion. Symptomatic lesions should be excised, and this can be safely carried out by minimally invasive techniques depending on the size and the anatomical location.