Ectopic pancreas

Introduction to pancreatic ectopic Pancreatic ectopic, also known as the vagus pancreas, where sporadic pancreatic tissue that grows outside the pancreas itself and is not connected to the normal pancreas is called pancreatic ectopic, it has no anatomical connection with normal pancreatic tissue, and no vascular Contact is a congenital disease. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: jaundice abdominal pain

Ectopic cause of pancreas

(1) Causes of the disease

The exact pathogenesis of pancreatic ectopic is unclear. Sharma calls it a "mystery". At present, there are mainly the following theories: 1 The tissue isolated from the pancreas during the embryonic stage or the inflammatory adhesion of the pancreas to the surrounding tissue causes the pancreatic tissue to be transplanted. In the adjacent organs; 2 intestinal wall pancreatic nodules in the embryo development with the longitudinal growth and rotation of the intestines are brought to the farther from the pancreas; 3 a small number of pancreatic ectopic can also be located in the lungs, mediastinum or other rare parts, Some people think that this is a phenomenon of returning to the ancestors, because many lower mammals are like this.

The role of teratogenic factors is closely related to the rate of division and differentiation of embryonic cells. The occurrence of pancreatic ectopic is believed to be mainly related to the remnant of the primordium during the embryonic period, and the primordium of the pancreas is one or several. The cells remain in the original intestinal wall. With the relevant organs in the primitive intestine, the basal remains of the dorsal pancreas will be brought to the stomach to produce ectopic tissue of the pancreas; the basal remains of the ventral pancreas will be shaken. 13.19. Fang Shuo Meckel's diverticulum), lung, tracheal pancreatic ectopic.

(two) pathogenesis

1. Pancreatic ectopic occurrence of pancreatic ectopic can occur outside the digestive tract and digestive tract, and even outside the abdominal cavity, but most commonly in the stomach and duodenum (Figure 1), according to Pearson collection of 589 cases, followed by Duodenum (30%), stomach (25%), jejunum (15%), Merkel's diverticulum (6%), ileum (3%); less common in omentum, mesentery, colon, appendix, gallbladder, Liver, spleen, common bile duct, perirenal; rare in the lung, mediastinum, trachea or esophagus, wherein the gastric pancreatic ectopic is more common in the antrum of the stomach, and most of them are located in the large curved side and the posterior wall within 6.0 cm from the pylorus, twelve The pancreatic ectopic of the finger is mainly located above the nipple and is common in the ball. According to the data collected by Ding Shihai, the ectopic parts of the pancreas in the country are stomach (49.8%), jejunum (22.4%), duodenum (11.9%). The ileum (11.9%), the other located in the common bile duct, peripancreatic fat tissue, ascending colon, 1 case, of which the gastric ectopic pancreatic ectopic is mainly in the sinus, accounting for 84.8% of the stomach, the body accounted for 15.2%, domestic and external pancreas The common parts of the position are different. The number of duodenum in China is less than that in foreign countries. It is considered that the duodenum is more than the digestive tract. Home difficult, not easy to find or overlooked relevant.

2. Morphological performance

(1) Gross morphology: Pancreatic ectopic is generally located under the mucosa of the gastrointestinal tract, followed by the muscle layer or muscle fibers, but rare in the serosal surface, which can be hemispherical, conical and papillary when protruding into the cavity. The surface may have one or several catheter openings; the appearance is mostly pale yellow or light red, similar to the normal pancreatic color; mostly single lobulated nodules, many rare; usually about 0.5 ~ 3.0cm in diameter, the smallest is only in It was found under the microscope that the largest one was recorded as 20cm × 1cm, but rarely more than 6cm; there was no capsule, and it could not be completely stripped. Because pancreatic ectopic can secrete pancreatic enzyme and alkaline pancreatic juice, inflammation and ulceration occur on the surface mucosa. Even bleeding.

(2) Microscopic findings: microscopic structure of the pancreas can be seen under the microscope, with acinar and ductal, even islets, which are divided into 3 types: 1 constructed by pancreatic islets and ducts, rare islets of this type; 2 by pancreatic duct and smooth muscle The composition, also named adenomyoma or myoepithelial hamartoma, mostly occurs in the stomach, gallbladder; 3 types of two types of mixed type, is a more common type.

Pancreatic ectopic tissue Like the normal pancreas, any lesion of the pancreas can occur, such as acute, chronic inflammation or ulceration, as well as pathological changes such as cysts, adenomas, islet cells, and pancreatic cancer.

Pancreatic ectopic prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Pancreatic ectopic complications Complications jaundice abdominal pain

Pancreatic ectopic location around the duodenal papilla can cause obstructive jaundice; in the small intestine, especially in the distal part of the ileum can induce intussusception, causing the corresponding symptoms; located in the gallbladder, gallbladder wall can be filled with filling defects It is fixed, gallstone can move, but it is difficult to distinguish from benign tumor of gallbladder wall. Pancreatic ectopic is stimulated by digestive juice, secretes protease, causes inflammation of surrounding tissue, ulceration and erosion of gastrointestinal mucosal blood vessels, etc. Symptoms such as abdominal pain and "tar" can occur.

Pancreatic ectopic symptoms common symptoms biliary obstruction intestinal mucosa necrotic ulcer mucosal congestion

In view of the location, size, number, pathology and secondary lesions of pancreatic ectopic, the clinical symptoms are more variable, but there is no characteristic, most of them can have no clinical manifestations, and can also appear in the organs. Different obstructions, hemorrhage, and symptoms of the tumor were classified into six categories according to their symptoms.

1. Obstructive type Because the pancreatic ectopic is a tumor-like lesion, it can cause compression or stenosis of the organ and cause obstruction symptoms. For example, it can cause pyloric obstruction in the antrum of the stomach; it can cause biliary obstruction in the duodenal papilla.

2. Gastrointestinal hemorrhage Nelson reported that gastrointestinal dysfunction caused by ectopic pancreatic edema accounted for 8.57%. The reason was that the gastrointestinal mucosa around the ectopic pancreas was hyperemia, ulceration, ulceration, or erosion of gastrointestinal mucosal blood vessels.

3. Ulcer-type pancreatic ectopic location in the anterior pyloric region, due to secretion of trypsin, digestion of mucosa to form ulcers; or submucosal pancreatic ectopic compression of the upper mucosa caused by mucosal atrophy and ulceration.

4. Tumor type Because the pancreatic ectopic is mostly located in the submucosa or muscle layer, it causes local uplift and is easily mistaken for tumor during barium meal examination.

5. Diverticulum pancreatic ectopic often occurs in the sputum.

6. Occult pancreatic ectopic is a congenital dysplasia, often to young and middle-aged symptoms, some life-time asymptomatic, only found in the autopsy of pancreatic ectopic.

Pancreatic ectopic examination

So far, there are no laboratory indicators, which can be used as a basis for diagnosing this disease. If pancreatic ectopic coexisting islet cell tumor, gastrinoma, etc., it will be able to detect elevated blood glucose, glucagon or gastrin levels, etc. .

1. Imaging examination

(1) B-ultrasound examination: the stomach, duodenal wall on the ultrasound map from the lumen to the serosa, in turn high-low-high-low-high echo (stomach cavity to mucosal interface - mucosa and mucosal muscle layer - submucosa - smooth muscle layer - subserosal and serosal layer), if the stomach, duodenal wall of the pancreas is more ectopic, or can be found from the ultrasound map, such as the use of intraluminal biplane probe, It can increase the rate of discovery. The person standing in the gallbladder wall has a strong echo-like change, which does not change with the body position.

(2) X-ray examination: Tincture examination has certain significance for the ectopic pancreas located in the stomach wall, especially the pylorus. Typical lesions can be seen in the local filling defect, the boundary is clear, the surface is smooth, the base is slightly wide, inactive, and the pancreas is ectopic. If there is a catheter opening, the tincture can be seen in the center of the compression piece in the filling defect area, which is similar to the ulcer shadow, also known as the umbilical sign, and is cut on the filling defect area, or a thin tubular sputum shadow can be seen, which is about 0.2~ 1.0cm, about 0.2-0.5cm wide, is called catheter sign, but sometimes it is often misdiagnosed as gastrointestinal "leioroma", "polyp", "malignant tumor", etc., in the diverticulum, the tincture can present the diverticulum Morphology, but it is difficult to show pancreatic ectopic itself. According to Neble, in 122 cases of pathologically confirmed pancreatic ectopic, only 17 cases (13.9%) were confirmed by expectorant examination, indicating the diagnosis rate of X-ray barium examination. not tall.

If the pancreatic ectopic causes small intestine stenosis, the X-ray abdominal plain film will show signs of intestinal dilatation, fluid level and other partial intestinal obstruction.

Larger pancreatic ectopic CT-enhanced scans, spiral CT, CT three-dimensional imaging or MRI can detect masses on the stomach or intestinal wall, but it is difficult to make a correct qualitative diagnosis.

2. Endoscopy

Fiber endoscopy, especially electron endoscopy, endoscopic ultrasonography can more clearly see the bulging lesions protruding into the cavity, or visible ulcers, and even the opening of the ectopic pancreatic duct, although endoscopic biopsy may obtain a pathological diagnosis, given the pancreas Ectopic burial is often buried under the mucosa, even deeper. In fact, it is difficult to obtain ectopic tissue of the pancreas by endoscopic forceps. For ectopic pancreatic ectopic examination of the digestive tract outside the omentum, mesentery, liver, spleen, etc., laparoscopic examination will have Help, ERCP can be used as a method to distinguish from common bile duct stones, ampullary carcinoma, and pancreatic head cancer.

Diagnosis of pancreatic ectopic diagnosis

In clinical work, patients with digestive tract obstruction, hemorrhage, ulcer, diverticulum and bulging lesions should be aware of the possibility of pancreatic ectopic, which is occasionally found in surgery or autopsy. In recent years, due to imaging With the extensive development of endoscopy, pancreatic ectopic in some areas can be clearly diagnosed by gastrointestinal angiography, endoscopic ultrasound and fiber endoscopy.

There are many types of pancreatic diseases, which can also occur in ectopic pancreas, such as pancreatic fistula, pancreatic cyst, pancreatic endocrine tumor, pancreatic stone disease, pancreatic ascariasis and pancreatic ascites. Clinically, it must be identified according to different conditions.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.