Gastric outlet obstruction caused by heterotopic pancreas in a patient with alcohol use disorder

Sarah Mirzaie; Theodore X Hu; Lu Yang; Katy L Lawson; Mark D Girgis

doi:10.1016/j.ijscr.2023.107974

Gastric outlet obstruction caused by heterotopic pancreas in a patient with alcohol use disorder

Int J Surg Case Rep. 2023 Apr:105:107974. doi: 10.1016/j.ijscr.2023.107974. Epub 2023 Mar 16.

Authors

Sarah Mirzaie¹, Theodore X Hu², Lu Yang², Katy L Lawson³, Mark D Girgis²

Affiliations

¹ David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA. Electronic address: smirzaie@mednet.ucla.edu.
² David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA.
³ Department of Pathology and Laboratory Medicine, David Geffen School of Medicine and Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA 90095, USA.

Abstract

Introduction and importance: Heterotopic Pancreas (HP) is defined by the presence of pancreatic tissue in an anatomically distinct location from the main pancreas. While often clinically silent, it may present symptomatically. If located in the gastric antrum, HP may cause gastric outlet obstruction (GOO). The objective of this paper is to present a rare case of HP in the gastric antrum causing GOO.

Case presentation: Herein, we report a 43-year-old man who presented with abdominal pain and non-bilious emesis in the setting of COVID-19 infection and alcohol consumption. During the initial workup, computed-tomography (CT) was non-specific but demonstrated GOO, concerning for cancer. Cold forceps biopsies taken during esophagogastroduodenoscopy (EGD) confirmed benign HP. Since the patient was symptomatic from gastric outlet compression, he underwent resection via laparoscopic distal gastrectomy and Billroth II gastrojejunostomy. At 1-month postoperative follow-up, the patient recovered uneventfully. We hypothesized that GOO by HP in this case may have been associated with cumulative effects of alcohol consumption and COVID-19 infection on the ectopic tissue.

Clinical discussion: HP is rare and difficult to diagnose preoperatively. When located in gastric antrum, HP can cause GOO, mimicking gastric malignancy. Combination of EGD/EUS, biopsy/FNA, and surgical resection are necessary to definitively make the diagnosis. Finally, it is important to consider that heterotopic pancreatitis or structural changes in HP may occur due to classic pancreatic stressors like alcohol and viral infections.

Conclusion: HP may cause GOO presenting with non-bilious emesis and abdominal pain, mistaken for malignancy on CT imaging.

Keywords: COVID-19; Case report; Gastric outlet obstruction; Heterotopic pancreas.

Publication types

Case Reports