Korean J Hepatobiliary Pancreat Surg.  2011 Aug;15(3):194-197. 10.14701/kjhbps.2011.15.3.194.

Partial gastric outlet obstruction caused by a huge submucosal tumor originating in the heterotopic pancreas

• Jung GO
• Park DE
• Yun KJ
• Chae KM

• KMID: 2130993
• DOI: http://doi.org/10.14701/kjhbps.2011.15.3.194

Abstract

A 21-year-old woman presented gastrointestinal manifestation showing intermittent abdominal pain, nausea, and vomiting. An upper endoscopic examination showed round, elevated mucosa at the antrum of the stomach anterior wall. After CT scanning, a huge degenerated gastrointestinal stromal tumor was suspected. Subtotal gastrectomy with Billroth II anastomosis was performed. Histologically, pseudocystic degeneration of the heterotopic pancreas was confirmed. The patient showed eventful postoperative course except temporary dilated gastric emptying. The patient is doing well without any abnormal symptom at 8-month follow-up. This report is a rare case of gastric outlet obstruction caused by a pseudocyst originating from a heterotopic pancreas in the gastric antrum.

Keyword

Heterotopic pancreas; Gastric outlet obstruction; Submucosal tumor

MeSH Terms

Abdominal Pain
Female
Follow-Up Studies
Gastrectomy
Gastric Emptying
Gastric Outlet Obstruction
Gastroenterostomy
Gastrointestinal Stromal Tumors
Humans
Mucous Membrane
Nausea
Pancreas
Pyloric Antrum
Stomach
Vomiting
Young Adult

Figure

• 

  Fig. 1 Computed tomography image shows a large cystic mass with multi-septated small cystic mass with enhancement in the delayed phase. Although the boundary between the cystic lesion and gastric antral wall was indistinct, there was no evidence of local invasion around solid organs and tissue.

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  Fig. 2 Magnetic resonance imaging study showing a definitive cystic mass in T2 weighted imaging. There was no connection between the cystic mass and the pancreatic duct or common bile duct.

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  Fig. 3 Photograph of gross specimen showing that the size of cystic mass was 7.5×5 cm and contained yellowish pus-like fluid. The wall of the cystic mass showed thickening with fibrous trabecular structures. No connection was seen between the mucosa wall in the gastric antrum and the cystic mass.

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  Fig. 4 Microscopic photograph showed benign grandular tissue within the muscle layer with presence of islets of Langerhans and cystic changes in ductular structure. There was no evidence of pancreatic acinar formation. (A: H&E stain, ×100, B: H&E stain, ×200).

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