2017 Volume 37 Issue 7 Pages 1081-1085
Gastroscopy performed on a 66-year-old man in June 2015 revealed complete, circumferential, elevated mucosal hypertrophy of the antrum. He was referred to our hospital. Abdominal computed tomography revealed cystic lesions in the wall of the stomach. A gastric mucosal biopsy and endoscopic puncture aspiration cytology showed no malignant findings. The pancreatic type amylase and CA 19-9 levels were elevated in the cystic lesion. We suspected an ectopic pancreas causing pyloric stenosis. We scheduled surgery to treat the stenosis, but the cystic lesion grew rapidly and burst the day before surgery was scheduled. During surgery, we observed an old hematoma and hemorrhagic ascites in the abdominal cavity. We diagnosed rupture of the cystic lesion. Because there was a possibility of latent cancer in the ectopic pancreas, we performed a laparoscopy-assisted distal gastrectomy with lymph node dissection and washed the abdominal cavity. The pathological diagnosis was ectopic pancreas, Heinrich type Ⅱ. The patient made satisfactory progress. It is rare for an ectopic pancreas to cause pyloric stenosis and rupture with bleeding, as in our case. We should examine and treat carefully with emergency surgery in mind when an ectopic pancreas has a cystic lesion.
