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Pancreatic tissue in antral wall
Pancreatic
Tissue
in Antral
W. EDWARD FRENCH, M.D., Memphis,
Wall
Tennessee
From the Department of Surgery, The University of Tennessee College of Medicine, and the Department of Surgery, Baptist Memorial Hospital, Memphis, Tennessee.
P
ANCREATIC tissue within the wall of the
stomach is found much more frequently by the pathologist, usually at postmortem examination, than by the surgeon. Nevertheless, this lesion should be suspected when peculiar and bizarre shadows are seen radiologically in the antrum of the stomach. Two cases in patients who were recently seen and operated upon form the basis of this report. The embryologic and anatomic relationship of the head of the pancreas may explain why the most frequent location of aberrant pancreatic tissue is found within those structures about the head of the pancreas, The antrum of the stomach and the duodenum are the most frequent site of occurrence. However, in a very extensive review [l], these rests were reported to be anywhere within the gastrointestinal tract. Although the exact pathogenesis of heterotopic pancreas is unknown, it is not too difficult to understand how rests may occur in the structure adjacent to the pancreas. .Explanation of how rests are found in a location far removed from the pancreas is not available. However, it is thought by Arey that in the elongation of the gastrointestinal tract a portion of pancreas may be carried away from the remainder of the gland.
FIG. 1. CASE I. Radiogram showing
antrum
the the stomach; this shadow was interpreted
and again the polyp was The patient was for other reasons and gastrotomy was the polyp. The polyp not be found, but near pylorus was found and
This tissue was cent the cases of aberrant tissue [Z]. It caused its location did not interfere with the the pyloric and mucosa over the revealed evidence of ulceration.
are 75 according
CASE II. A seventy-two year old white man with a fifteen year history and radiologic evidence of pyloric obstruction was admitted to the hospital because of a high gastric ulcer on the lesser curvature. For the fifteen years this man had had mild symptoms of pyloric obstruction. The radiographs (Fig. 2) greatly resembled those usually seen in patients with adult type hypertrophic pyloric stenosis. Because of the paucity of symptoms, however, correction of the obstruction had not been advised at the time. When the patient was finally operated upon for the gastric ulcer, the pathologist discovered aberrant pancreas to be the cause of the pyloric obstruction.
CASE REPORTS A fifty-three year old white man was first examined radiologically because of a long history of ulcer disease. (Fig. 1.) The radiologist also reported the presence of an antral polyp. Subsequent studies made during a four year period in the same radiology department but by different radiologists confirmed the presence of the polyp. No symptoms were referable to the polyp. On September 8, 1966, the patient was admitted CASE I.
956
American Journal
of Surgery
Pancreatic Tissue in Antral Wall in such a patient may produce what resembles hypertrophic pyloric stenosis [3]. The overlying mucosa may ulcerate and produce many of the symptoms and findings of peptic ulcer disease [P]. SUMMARY
Two cases of aberrant pancreas which were seen within two weeks of each other are reported. Both caused definite radiographic findings, but only one patient experienced vague symptoms as a result of the lesion. One patient was diagnosed preoperatively as having a gastric polyp, and the other patient was diagnosed as having adult hypertrophic pyloric obstruction of undetermined cause. FIG. 2. CASE II. Spot films made during fluoroscopy of antrnm and pyloric canal. This finding led to a diagnosis of adult hypertrophic pyloric stenosis. COMMENTS
Aberrant pancreas usually causes no symptoms and thus is usually discovered incidentally. However, because of its location, definite but confusing symptoms may be produced. Located near the pyforus, the rest may produce a partial obstruction, as in case II. A radiograph
Vol. 114, Dcccmber 1967
REFERENCES 1. BARBOSA, J. J. C., DOCKERTY, M. D., and WAUGH, J. M. Pancreatic heterotopic: Review of the literature and report of 41 authenticated surgical cases of which 25 were clinically significant. Surg. Gynec. 6’ Obst., 82: 527, 1946. 2. PALMER, E. D. Benign intramural tumors of the stomach. Medicine. 30: 81. 1951 3. ABRAHAMS, J. I. Heterotopic pancreas simulating peptic ulceration. ArcA. Surg., 93: 589, 1966. 4. HEMP&L, G. K., BROCHU, F. L., and HAYS, R. P. Aberrant pancreas of the stomach. Am. Surgeon, 31: 267, 1965.
Tissue
in Antral
W. EDWARD FRENCH, M.D., Memphis,
Wall
Tennessee
From the Department of Surgery, The University of Tennessee College of Medicine, and the Department of Surgery, Baptist Memorial Hospital, Memphis, Tennessee.
P
ANCREATIC tissue within the wall of the
stomach is found much more frequently by the pathologist, usually at postmortem examination, than by the surgeon. Nevertheless, this lesion should be suspected when peculiar and bizarre shadows are seen radiologically in the antrum of the stomach. Two cases in patients who were recently seen and operated upon form the basis of this report. The embryologic and anatomic relationship of the head of the pancreas may explain why the most frequent location of aberrant pancreatic tissue is found within those structures about the head of the pancreas, The antrum of the stomach and the duodenum are the most frequent site of occurrence. However, in a very extensive review [l], these rests were reported to be anywhere within the gastrointestinal tract. Although the exact pathogenesis of heterotopic pancreas is unknown, it is not too difficult to understand how rests may occur in the structure adjacent to the pancreas. .Explanation of how rests are found in a location far removed from the pancreas is not available. However, it is thought by Arey that in the elongation of the gastrointestinal tract a portion of pancreas may be carried away from the remainder of the gland.
FIG. 1. CASE I. Radiogram showing
antrum
the the stomach; this shadow was interpreted
and again the polyp was The patient was for other reasons and gastrotomy was the polyp. The polyp not be found, but near pylorus was found and
This tissue was cent the cases of aberrant tissue [Z]. It caused its location did not interfere with the the pyloric and mucosa over the revealed evidence of ulceration.
are 75 according
CASE II. A seventy-two year old white man with a fifteen year history and radiologic evidence of pyloric obstruction was admitted to the hospital because of a high gastric ulcer on the lesser curvature. For the fifteen years this man had had mild symptoms of pyloric obstruction. The radiographs (Fig. 2) greatly resembled those usually seen in patients with adult type hypertrophic pyloric stenosis. Because of the paucity of symptoms, however, correction of the obstruction had not been advised at the time. When the patient was finally operated upon for the gastric ulcer, the pathologist discovered aberrant pancreas to be the cause of the pyloric obstruction.
CASE REPORTS A fifty-three year old white man was first examined radiologically because of a long history of ulcer disease. (Fig. 1.) The radiologist also reported the presence of an antral polyp. Subsequent studies made during a four year period in the same radiology department but by different radiologists confirmed the presence of the polyp. No symptoms were referable to the polyp. On September 8, 1966, the patient was admitted CASE I.
956
American Journal
of Surgery
Pancreatic Tissue in Antral Wall in such a patient may produce what resembles hypertrophic pyloric stenosis [3]. The overlying mucosa may ulcerate and produce many of the symptoms and findings of peptic ulcer disease [P]. SUMMARY
Two cases of aberrant pancreas which were seen within two weeks of each other are reported. Both caused definite radiographic findings, but only one patient experienced vague symptoms as a result of the lesion. One patient was diagnosed preoperatively as having a gastric polyp, and the other patient was diagnosed as having adult hypertrophic pyloric obstruction of undetermined cause. FIG. 2. CASE II. Spot films made during fluoroscopy of antrnm and pyloric canal. This finding led to a diagnosis of adult hypertrophic pyloric stenosis. COMMENTS
Aberrant pancreas usually causes no symptoms and thus is usually discovered incidentally. However, because of its location, definite but confusing symptoms may be produced. Located near the pyforus, the rest may produce a partial obstruction, as in case II. A radiograph
Vol. 114, Dcccmber 1967
REFERENCES 1. BARBOSA, J. J. C., DOCKERTY, M. D., and WAUGH, J. M. Pancreatic heterotopic: Review of the literature and report of 41 authenticated surgical cases of which 25 were clinically significant. Surg. Gynec. 6’ Obst., 82: 527, 1946. 2. PALMER, E. D. Benign intramural tumors of the stomach. Medicine. 30: 81. 1951 3. ABRAHAMS, J. I. Heterotopic pancreas simulating peptic ulceration. ArcA. Surg., 93: 589, 1966. 4. HEMP&L, G. K., BROCHU, F. L., and HAYS, R. P. Aberrant pancreas of the stomach. Am. Surgeon, 31: 267, 1965.