Laparoscopic Gastrectomy for Heterotopic Pancreas with Concurrent Gastroduodenal Invagination and Gastric Wall Abscess: A Case Report

Abstract

INTRODUCTION: Heterotopic pancreas refers to pancreatic tissue located outside its normal position and lacking anatomical or vascular continuity with the pancreas. Gastric heterotopic pancreas (GHP) is generally asymptomatic, but in rare cases large GHP lesions can cause gastric outlet syndrome or gastroduodenal invagination. GHP may also occasionally cause acute pancreatitis and abscess formation in the gastric wall. This report describes a rare case of GHP with concurrent gastroduodenal invagination and gastric wall abscess treated via laparoscopic distal gastrectomy.

CASE PRESENTATION: A 46-year-old man was admitted to the hospital with abdominal pain and vomiting. Computed tomography revealed a 40-mm low-density mass in the gastric pylorus, and gastroduodenal invagination. Gastroscopy confirmed a submucosal lesion at the gastric pylorus causing pyloric stenosis. The patient underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction. Histopathological examination revealed a gastric submucosal lesion containing pancreatic tissue with acinar cells and ducts, without islets of Langerhans, leading to a diagnosis of Heinrich type II GHP. The submucosal lesion also contained inflammatory components such as neutrophils and foamy histiocytes, forming a gastric wall abscess. Finally, the patient was discharged on postoperative day 11 and is progressing well 7 months after surgery.

CONCLUSIONS: Herein we report the first case of laparoscopic distal gastrectomy for GHP with concurrent gastroduodenal invagination and gastric wall abscess resulting in a favorable outcome.