Nancy Panko, MD1, Gerrit Dunford, MD2, Kenneth Copperwheat, DO2, Rami Lutfi, MD2. 1Houston Northwest Medical Center, 2Saint Joseph Hospital
Introduction: Heterotopic pancreas is rare, with few reports in the literature. We describe a patient undergoing bariatric surgery with an incidentally discovered gastric mass. After resection, this mass proved to be heterotopic pancreas.
Case: Patient is a 35 year old woman with morbid obesity and lap band placement. She underwent removal of the lap band for complaints of dysphagia, and underwent bariatric workup, including preoperative EGD. She had no abnormal findings and elected to proceed with sleeve gastrectomy.
On the operating room, she was found to have a 3 cm exophytic mass near the lesser curvature of the stomach. We performed intraoperative endoscopy and did not appreciate any mucosal involvement. We did not biopsy the mass, as we did not want to seed the abdomen if this proved to be a malignancy. The mass was near the incisura, and there was concern that performing the sleeve and resecting the mass with the stomach remnant would create too narrow a sleeve. We aborted the procedure and brought the patient back to the clinic to discuss the findings.
After discussing management options with the patient, we decided to move forward with gastric bypass and resection of the mass. The patient was taken to the operating room. We created our gastric pouch by first identifying the mass and then creating a window into the lesser sac 5 cm below the GE junction. We then constructed a vagal sparing gastric pouch staying superior to the mass. We evaluated the mass within the gastric remnant and performed a wedge resection using two staple loads. We were able to obtain clear margins grossly. This was sent to pathology for frozen section, and did not show evidence of malignancy. We inspected the posterior wall of the remnant to ensure that there were no other occult masses and there were none. We completed the bypass and performed completion endoscopy, which was normal.
Final pathology revealed heterotopic pancreas. The patient recovered from surgery without difficulty and has been doing well postoperatively.
Discussion: Heterotopic pancreas is defined as pancreatic tissue with devoted vascular and ductal structures in the GI tract without continuity to the pancreas. They are most commonly found in the stomach and can be asymptomatic, although occasionally can cause inflammation, bleeding, or infection. They grossly appear similar to gastrointestinal stromal tumors, carcinoids, and lymphoma. Although rare, heterotopic pancreas should be considered in the differential for extramucosal gastric tumors.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95392
Program Number: V183
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop