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Pancreatic Heterotopia of the Duodenum: Anatomic Anomaly or Clinical Challenge?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Pancreatic heterotopia (PH) is a common congenital anomaly and can occur anywhere in the gastrointestinal tract (GIT). In most cases, these heterotopias are asymptomatic and are only incidentally detected upon pathohistological examination or autopsy. We analyzed our cases of duodenal PH with respect to their clinical relevance and impact.

Materials and Methods

Our prospectively collected pancreatic database was retrospectively analyzed. Thirty-four cases of duodenal PH were found. Specimens were reviewed by a GI pathologist. Classification was performed according to Heinrich (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts).

Results

From January 2000 to June 2009, we performed 534 pancreatic head resections. Thirty-two patients (6.0%) were found to have duodenal PH. Indications for pancreatic resections (pylorus-preserving pancreaticoduodenectomy, n = 26; Whipple, n = 6) were as follows: chronic pancreatitis, n = 16; malignancies, n = 9; cystic neoplasms, n = 5; and neuroendocrine neoplasms, n = 2. PH was also detected after two partial duodenal resections. In total, two cases of duodenal PH were found to be symptomatic. According to Heinrich, the following types were found: Type I, n = 12; Type II, n = 17; and Type III, n = 5 (total n = 34).

Conclusions

PH is rare and in most cases detected incidentally during pathohistological examination. However, in two of our patients, surgery was performed due to symptoms. Therefore, in patients with unclear pancreatoduodenal lesions, PH should be considered as a possible diagnosis. Resection is indicated for symptomatic cases.

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Abbreviations

GIT:

Gastrointestinal tract

PH:

Pancreatic heterotopia

PPPD:

Pylorus-preserving pancreaticoduodenectomy

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Authors and Affiliations

  1. Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Marius Distler, Felix Rückert, Hans-Detlev Saeger & Robert Grützmann

  2. Institute of Pathology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

    Daniela Aust

  3. Department of Visceral, Thoracic, and Vascular Surgery, Technical University Hospital, Fetscher Str. 74, 01307, Dresden, Germany

    Marius Distler

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  1. Marius Distler
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  2. Felix Rückert
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Correspondence to Marius Distler.

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Distler, M., Rückert, F., Aust, D. et al. Pancreatic Heterotopia of the Duodenum: Anatomic Anomaly or Clinical Challenge?. J Gastrointest Surg 15, 631–636 (2011). https://doi.org/10.1007/s11605-011-1420-2

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  • DOI: https://doi.org/10.1007/s11605-011-1420-2

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