Pediatr Gastroenterol Hepatol Nutr.  2014 Sep;17(3):196-200. 10.5223/pghn.2014.17.3.196.

How Should the Pyloric Submucosal Mass Coexisting with Hypertrophic Pyloric Stenosis Be Treated?: A Case of Pyloric Ectopic Pancreas with Hypertrophic Pyloric Stenosis

• Kim SH
• Yoo TK
• Kim HY
• Jung SE
• Park KW

• KMID: 1803121
• DOI: http://doi.org/10.5223/pghn.2014.17.3.196

Abstract

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.

Keyword

Pyloric stenosis; Hypertrophic; Ectopic pancreas; Gastric submucosal mass; Infant

MeSH Terms

Humans
Infant
Laparotomy
Male
Pancreas*
Pyloric Stenosis
Pyloric Stenosis, Hypertrophic*
Pylorus
Vomiting

Figure

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  Fig. 1 Abdomen ultrasonography. (A) 0.8×0.7×0.4 cm intramural cystic lesion at the anterior wall of the pylorus (arrow). (B) Hypertrophied pyloric muscle (arrow).

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  Fig. 2 Fluoroscopic upper gastrointestinal contrast study. Narrowing and shouldering at the pylorus (arrows) consistent with hypertrophic pyloric stenosis.

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  Fig. 3 Magnetic resonance imaging. T2 bright signal intensity and non-enhancing submucosal cystic lesion at the lateral wall of the pylorus (arrows).

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  Fig. 4 Gross finding. Submucosal pyloric mass.

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  Fig. 5 Microscopic finding. Hypertrophied outer proper muscle (arrows) with heterotopic pancreas (arrowheads) (H&E, ×200).

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