Heterotopic pancreas. A difficult diagnosis.

Heterotopic pancreas is seen in one of every 500 laparotomies or 0.55-13% of autopsies. Despite modern diagnostic procedures (endoscopy, endoscopic ultrasound) it is difficult to diagnose preoperatively. A 51-year-old patient with a 30-year history of recurrent gastric ulcers was diagnosed with a gastric wall tumor. Endoscopic biopsy sample showed normal gastric mucosa. Endoscopic ultrasound and contrast radiography were not able to specify the gastric wall tumor. The local excision and histologic preparation of the tumor showed heterotopic pancreatic tissue within the gastric submucosa without any signs of malignancy. Three years postoperatively the patient is without any complaints. There have been no further signs of gastric ulcers.