Ectopic pancreas is no longer a rare clinical condition, but its unusual clinical manifestations, locations or complications are of clinical interest. We experienced a case (a 48 year-old male patient) of duodenal ectopic pancreas complicated by chronic pancreatitis and pseudocyst formation of which preoperative imaging findings mimicked a large duodenal submucosal tumor with cystic degeneration such as a leiomyosarcoma. Simultaneous chronic pancreatitis was also demonstrated in the isotopic pancreas of the patient postoperatively. Herein we report a rare clinical condition occurring in an ectopic pancreas with a brief review of the literature.
Case Report ; Choristoma/complications/*diagnosis ; Chronic Disease ; Diagnosis, Differential ; Duodenal Diseases/complications/*diagnosis ; Duodenal Neoplasms/diagnosis ; Human ; Male ; Middle Age ; *Pancreas ; Pancreatic Pseudocyst/complications/*diagnosis ; Pancreatitis/complications/*diagnosis

A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We describe the second case of adenocarcinoma arising in a gastric heterotopic pancreas of an asymptomatic 35-yr-old man in Korea. Esophagogastroduodenoscopy revealed a submucosal tumor with an irregular central umbilication in the gastric antrum. A wedge resection specimen demonstrated a submucosal oligolocular cystic mass (1.7x1.4x1.2 cm) with a solid portion. Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures. The adenocarcinoma components in the solid area infiltrated the proper muscle and the overlying mucosa of the stomach. The transitional area between the benign ductal structures and the adenocarcinoma component was found. The follow-up course was uneventful 5 months postoperatively.
Adenocarcinoma/complications/*diagnosis/pathology ; Adenomyoma/pathology ; Adult ; Autopsy ; Choristoma ; Epithelium/pathology ; Gastric Mucosa/pathology ; Human ; Male ; Pancreas/*abnormalities ; Pancreatic Neoplasms/complications/*diagnosis/pathology ; Time Factors

Choristoma ; complications ; diagnosis ; diagnostic imaging ; Duodenal Diseases ; complications ; diagnosis ; diagnostic imaging ; Duodenoscopy ; Fatal Outcome ; Female ; Humans ; Middle Aged ; Pancreas ; Shock, Septic ; etiology ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo investigate the clinical characteristics,diagnosis and treatment of intestinal heterotopic gastric mucosa resulting in alimentary tract hemorrhage.

METHODSEleven cases of intestinal heterotopic gastric mucosa with alimentary tract hemorrhage during the past 24 years in our hospital were reviewed and the clinical data were analyzed retrospectively.

RESULTSThe median age was 29 years old. Nine cases had abdominal pain, and radionuclide (99m)Tc-pertechnetate scan revealed bleeding lesion in 6 cases preoperatively. Segmental resection of the intestine with bleeding lesion were performed in all patients, postoperative pathology confirmed heterotopic gastric mucosa. The lesion was located in the jejunum in five cases and in the ileum in six cases. All lesions were complicated with diverticulum, or inflammatory mass on the intestinal wall, or abnormity of intestinal duplication.

CONCLUSIONSIntestinal heterotopic gastric mucosa is difficult to be diagnosed preoperatively, and radionuclide (99m)Tc-pertechnetate scan plays a role in preoperative diagnosis.

Adolescent ; Adult ; Choristoma ; complications ; diagnosis ; surgery ; Female ; Gastric Mucosa ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; surgery ; Humans ; Intestinal Diseases ; complications ; Intestines ; Male ; Middle Aged ; Young Adult

OBJECTIVECongenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. This study was conducted to understand the clinical features of TBR.

METHODThe data of the four cases with TBR admitted to our hospital and 76 patients identified from the literature were reviewed. The clinical manifestation, X-ray, endoscopy, biopsy and treatment were studied retrospectively.

RESULTOf the total of 80 cases, 45 were male, 33 were female, and for 2 cases the gender was unknown. Symptoms of dysphagia and regurgitation developed at the age of 1-day to 12-month. Definitive treatment was carried out at the age of 1-month to 16-year. Twenty-seven patients had associated anomalies with esophageal atresia being the most prevalent. X-ray esophagography showed segmental stenosis at the distal third of the esophagus in all patients except three. An abrupt narrow segment at the lower esophagus with marked proximal dilatation was found in 32 cases. Esophagography of 12 cases showed distal esophageal stenosis with tapered narrowing. Esophagography of 20 cases showed flask-shaped shadow of distal esophageal stenosis and one patient showed linear projection of barium at the level of stenosis. Endoscopy found almost complete obstruction of the lower esophageal lumen without signs of the esophagitis or reflux. Esophagoscopic dilatation of the stenosis was attempted in 24 cases, but was ineffective, and 3 patients suffered esophageal perforation. Seventy-nine patients underwent resection of the stenotic segment. Histologic examination of the resected specimen showed cartilage, mucus glands, resembling bronchal tissue. Post-operative complication included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux.

CONCLUSIONTBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food. Esophagography and esophagoscopy are the essential means for diagnosis. TBR should be different from achalasia and should be diagnosed by biopsy. Operation is the only choice of treatment.

Anastomosis, Surgical ; Barium Sulfate ; Biopsy ; Child, Preschool ; Choristoma ; complications ; Dilatation ; Esophageal Atresia ; complications ; Esophageal Perforation ; etiology ; Esophageal Stenosis ; congenital ; diagnosis ; pathology ; surgery ; Esophagoscopy ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Tracheoesophageal Fistula ; etiology

Meckel's diverticulum is an embryologic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract, affecting 1% to 2% of the general population. Although this prevalence is relatively low, Meckel's diverticulum is occasionally encountered as an incidental identification during abdominal exploration and can be associated with several life-threatening disease states, such as massive intestinal bleeding, intestinal obstruction, or on rare occasion, perforation. The management of a Meckel's diverticulum found incidentally on laparotomy is controversial because the rate of complications developing from the diverticulum remains uncertain. The data in this report are based on 18 cases of Meckel's diverticulum which were treated at the Department of Surgery, InJe University Sanggye Paik Hospital, during the 7 years between January 1990 and December 1996. The results are as follows: 1) The overall sex ratio of males to females was 5 : 1 and in the symptomatic group, the ratio was 6 : 1. 2) Ninety percent of the patients were under 40 years of age, and 56% were under 10. 3) The diverticula were located from 20 cm to 100 cm proximal to the ileocecal valve, and the average range was 53 cm from the ileocecal valve. Fifteen cases were located at the antimesenteric border, and 3 cases at the mesenteric border of the ileum. 4) The lengths of the diverticula ranged from 1cm to 6cm, and the diameters ranged from 0.5 cm to 4.5 cm. 5) Appendicitis and intestinal obstruction were the most frequent preoperative diagnoses in the symptomatic group. 6) The common complications were intestinal obstruction and inflammation. 7) Heterotopic tissues were found in three patients and all of them were ectopic gastric mucosa. 8) The treatment was a diverticulectomy or a segmental resection of the involved bowel. 9) Postoperative complications were found in three of the asymptomatic group: two early intestinal obstructions and one wound infection.
Appendicitis ; Choristoma ; Diagnosis ; Diverticulum ; Female ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Inflammation ; Intestinal Obstruction ; Laparotomy ; Male ; Meckel Diverticulum* ; Postoperative Complications ; Prevalence ; Sex Ratio ; Vitelline Duct ; Wound Infection

No abstract available.
Acute Disease ; Adult ; Anti-Bacterial Agents/therapeutic use ; Choristoma/*complications/radiography ; Escherichia coli Infections/diagnosis/drug therapy/*microbiology ; Female ; Hernias, Diaphragmatic, Congenital/*complications/radiography ; Humans ; *Kidney ; Predictive Value of Tests ; Pyelonephritis/diagnosis/drug therapy/*microbiology ; Thoracic Diseases/*complications/radiography ; Tomography, X-Ray Computed ; Treatment Outcome