Massive Lower Gastrointestinal Bleeding from Meckel’s Diverticulum with Heterotopic Pancreas: Case Report and a Brief Review of the Literature

  • Xing Yang Department of Pancreatic Surgery, First Affiliated Hospital of China Medical University. Shenyang, Liaoning, China
  • Kejian Guo Department of Pancreatic Surgery, First Affiliated Hospital of China Medical University. Shenyang, Liaoning, China
Keywords: Accessory pancreas [Supplementary Concept], Choristoma, Hemorrhage, Meckel Diverticulum, Pancreas

Abstract

Context Heterotopic pancreas is defined as pancreatic tissue found out of the pancreas proper with no vascular or anatomical connection. It is a rare clinical entity and can be found at any portion of the alimentary system. Case report We describe a case of Meckel’s diverticulum with heterotopic pancreas who presented massive lower gastrointestinal bleeding. Conclusion Lower gastrointestinal bleeding due to Meckel’s diverticulum with heterotopic pancreas is extremely difficult to make a definitive diagnosis preoperatively especially when it onsets rapidly.

Image: Mass arising from the distal end of the diverticulum.

Downloads

Download data is not yet available.

References

Song DE, Kwon Y, Kim KR, Oh ST, Kim JS. Adenocarcinoma arising in gastric heterotopic pancreas: a case report. J Korean Med Sci. 2004 Feb;19(1):145-8. [PMID 14966359]

Huang YC, Chen HM, Jan YY, Huang TL, Chen MF. Ectopic pancreas with gastric outlet obstruction: report of two cases and literature review. Chang Gung Med J 2002; 25:485-90. [PMID 12350037]

Neupert G, Appel P, Braun S, Tonus C. Heterotopic pancreas in the gallbladder. Diagnosis, therapy, and course of a rare developmental anomaly of the pancreas. Chirurg 2007; 78:261-4. [PMID 16775679]

Levy AD, Hobbs CM. From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation. Radiographics. 2004 Mar-Apr;24(2):565-87. [PMID 15026601]

Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D. Complications of Meckel's diverticula in adults. Can J Surg. 2006 Oct;49(5):353-7. [PMID 17152574]

Biswas A, Husain EA, Feakins RM, Abraham AT. Heterotopic pancreas mimicking cholangiocarcinoma. Case report and literature review. JOP. 2007;8(1):28-34. [PMID 17228130]

Kitsuki H, Iwasaki K, Yoshitomi S, Matsuura Y, Natsuaki Y, Torisu M. An adult case of bleeding Meckel's diverticulum diagnosed by preoperative angiography. Surg Today. 1993;23(10):926-8. [PMID 8298239]

Xiao WD, Chen W, Yang H. Heterotopic pancreas within Meckel's diverticulum with obscure then massive gastrointestinal bleeding in a 12-year-old child: case report and review of the literature. J Int Med Res. 2009 May-Jun;37(3):967-72. [PMID 19589283]

Koh HC, Page B, Black C, Brown I, Ballantyne S, Galloway DJ. Ectopic pancreatic-type malignancy presenting in a Meckel's diverticulum: a case report and review of the literature. World J Surg Oncol. 2009;7:54. [PMID 19545406]

Kopacova M, Vykouril L, Vacek Z, Tycova V, Bartova J, Rejchrt S, et al. Inverted Meckel's diverticulum with ectopic pancreatic tissue as a source of severe gastrointestinal bleeding. J Gastrointest Surg. 2010 Mar;14(3):578-81. [PMID 19274480]

Yang JF, Sun LM, Wang XF, Dai N. Massive gastrointestinal bleeding from Meckel diverticulum with ectopic pancreatic tissue. Chin Med J (Engl). 2011 Feb;124(4):631-3. [PMID 21362295]

Song LA. Meckel’s diverticulum with ectopic pancreatic tissue complicated massive low gastrointestinal bleeding. Acta Acad Med Nanjing (Chin) 1981; 1: 42-43.

Qing GX, Feng YR, Chen XC, Zhen SJ. Report of a case with massive bleeding due to ileum diverticulum with ectopic pancreatic tissue. J Hainan Med Coll (Chin) 1998; 4: 159.

Ding GS, Yang G. Report of a case with low gastrointestinal bleeding due to Meckel’s diverticulum with ectopic pancreatic tissue. Pract Clin Med (Chin) 2004; 5: 35.

Thomas RA, Gibson S, Paul M, McDonald SW. Jejunal diverticulum with ectopic pancreatic mucosa: was it really a Meckel's diverticulum? Clin Anat. 2012 May;25(4):509-12. [PMID 22488999]

Zarand A, Bajtai A, Baranyai Z, Dede K, Jakab F. Inflammation of ectopic pancreatic tissue in a Meckel's diverticulum causing acute abdominal symptoms: a case report and review of the literature. Int J Surg Pathol. 2011 Jun;19(3):359-63. [PMID 19223375]

Baysoy G, Balamtekin N, Uslu N, Karavelioglu A, Talim B, Ozen H. Double heterotopic pancreas and Meckel's diverticulum in a child: do they have a common origin? Turk J Pediatr. 2010 May-Jun;52(3):336-8. [PMID 20718198]

Mandal S, Mandal AK. Heterotopic pancreas presenting as a tumour nodule along with perforation and peritonitis is rare: report of two cases. ANZ J Surg. 2008 Aug;78(8):725. [PMID 18796045]

Monedero MD, Ripolles T, Nicolau MJ, Martinez-Perez MJ. Pancreatic pseudotumor in Meckel diverticulum. Abdom Imaging. 2006 Nov-Dec;31(6):688-90. [PMID 16465569]

Cates JM, Williams TL, Suriawinata AA. Intraductal papillary mucinous adenoma that arises from pancreatic heterotopia within a meckel diverticulum. Arch Pathol Lab Med. 2005 Mar;129(3):e67-9. [PMID 15737052]

Parsons S, Chow CW. Heterotopic pancreas without exocrine elements in the Meckel's diverticulum of an insulin-dependant diabetic. Pathology. 2003 Feb;35(1):83-5. [PMID 12701693]

Mourra N, Tiret E, Caplin S, Gendre JP, Parc R, Flejou JF. Involvement of Meckel diverticulum in Crohn disease associated with pancreatic heterotopia. Arch Pathol Lab Med. 2003 Feb;127(2):E99-E100. [PMID 12562264]

Schier F, Sauerbrey A, Kosmehl H. A Meckel's diverticulum containing pancreatic tissue and nesidioblastosis in a patient with Beckwith-Wiedemann syndrome. Pediatr Surg Int. 2000;16(1-2):124-7. [PMID 10663860]

Taylor RH, Owen DA. Acute inflammation of pancreatic tissue in a Meckel's diverticulum. Can J Surg. 1982 Nov;25(6):656-7. [PMID 7139421]

Ryu DY, Kim GH, Park do Y, Lee BE, Cheong JH, Kim DU, et al. Endoscopic removal of gastric ectopic pancreas: an initial experience with endoscopic submucosal dissection. World J Gastroenterol. 2010 Sep 28;16(36):4589-93. [PMID 20857531]

Kim JY, Lee JM, Kim KW, Park HS, Choi JY, Kim SH, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology. 2009 Jul;252(1):92-100. [PMID 19561251]

Kiratli PO, Aksoy T, Bozkurt MF, Orhan D. Detection of ectopic gastric mucosa using 99mTc pertechnetate: review of the literature. Ann Nucl Med. 2009 Feb;23(2):97-105. [PMID 19225931]

Kitsuki H, Iwasaki K, Yoshitomi S, Matsuura Y, Natsuaki Y, Torisu M. An adult case of bleeding Meckel's diverticulum diagnosed by preoperative angiography. Surg Today. 1993;23(10):926-8. [PMID 8298239]

Heinrich H. Ein Beitrag zur Histologie des sogen akzessorischen Pankreas. Virchows Arch Path Anat Physiol. 1909;198:392–401.

Mass arising from the distal end of the diverticulum
Published
2013-05-10
How to Cite
YangX., & GuoK. (2013). Massive Lower Gastrointestinal Bleeding from Meckel’s Diverticulum with Heterotopic Pancreas: Case Report and a Brief Review of the Literature. JOP. Journal of the Pancreas, 14(3), 269-272. https://doi.org/10.6092/1590-8577/1407
Section
CASE REPORTS