Journal de pathologie chirurgicale et de diagnostic

Incidental Finding of Gastric Heterotopic Pancreas during Laparoscopic Sleeve Gastrectomy: A Case Report

Abstract

Saleem Abdel Backi, Omar Tabbikha, Jad Al Bitar, Souad Ghattas and Raja Wakim*

Background: Heterotropic Pancreas (HP), also known as ectopic, accessory, or aberrant pancreas is by definition the presence of pancreatic tissue outside its normal anatomical location with no direct blood supply connection with the main pancreas. In the literature, there is increase in the incidence of pathological findings during laparoscopic sleeve gastrectomy. Here we present a case of HP incidentally found in the gastric antrum during laparoscopic sleeve gastrectomy.

Case presentation: 52-year-old female patient with BMI 46.49 kg/m2 presented to undergo laparoscopic sleeve gastrectomy. After the dissection of the greater curvature of the stomach from the omentum, a lesion at the greater curvature of the stomach on the antral-body junction was identified. Intra-operative gastroscopy was done that showed a benign looking polyploid lesion of the gastric wall with a probable overlying submucosal lesion. No intraluminal mass was identified so a decision to proceed with the surgery was taken and the transected stomach containing the suspected lesion was sent to pathology. The final pathology showed a type 1 2.2 cm heterotropic pancreas involving the submucosa and deep into the muscle.

Discussion and conclusion: HP is usually an asymptomatic pathology found incidentally; however, depending on its size, pathological changes, and anatomical location it can become clinically evident. Even though it is difficult to diagnose HP preoperatively, few radiological characteristics have beed identified that can help in the diagnosis. However, the definitive diagnosis of HP is made histologically. In the case of an incidental HP found during surgery, local excision is the preferred treatment since HP is at risk of becoming symptomatic or malignant when radical surgery is considered. In our case, the location and benign appearance of the lesion, in addition to the result on the gastroscopy allowed us to proceed with our intended surgery.