Aydemir ÖLMEZ, Cemalettin AYDIN, Gökhan SÖĞÜTLÜ, Hale KIRIMLIOĞLU, VEYSEL ERSAN, Cüneyt KAYAALP

Safra kesesi polibini taklit eden semptomatik heterotopik pankreas

Safra kesesi yerleşimli heterotopik pankreasın semptomatik olması son derece nadirdir. Bildirilen olguların çoğunda heterotopik pankreas patolojik inceleme sonrası tesadüfen saptanmıştır. Yirmibir yaşında erkek hasta bir yıldır olan karın ağrısı şikayeti ile başvurdu. Ultrasonografide safra kesesi boynuna yerleşimli 11x7 mm ve 3 mm boyutlarında iki adet polip saptandı. Semptomatik ve 1cm üzerinde polip olması nedeniyle hastaya kolesistektomi önerildi. Cerrahi tedaviyi kabul eden hastaya laparoskopik kolesistektomi uygulandı ve sonrasında hasta sorunsuz olarak taburcu edildi. Yapılan histopatolojik incelemede safra kesesi duvarında heterotopik pankreas dokusu tespit edildi. Geç dönem takiplerde (20 ay) hastanın şikayetlerinin ortadan kalktığı öğrenildi. Sonuç olarak safra kesesinde yerleşimli heterotopik pankreas, semptomlara neden olduğunda kolesistektomi ile tedavi edilmesi gereken ve safra kesesi içerisinde yer işgal eden kitlelerin ayırıcı tanısında akılda tutulması gereken bir patolojidir.

Symptomatic heterotopic pancreas in gallbladder mimicking polyps

Symptomatic heterotopic pancreas in gallbladder is very rare. Most reported cases were discovered incidentally with pathological examinations. Twenty-one year old man admitted for abdominal pain lasting for one year. Ultrasound revealed two polyps located in the neck of the gallbladder and 11x7mm and 3mm in sizes. Because polyps were symptomatic and larger than 1cm, we suggested cholecystectomy. Patient accepted surgery and laparoscopic cholecystectomy was performed. His postoperative course was uneventful. Histopathology demonstrated heterotopic pancreas in the gallbladder. He had no problems in the 20 months of follow-up. Symptomatic heterotopic pancreas in the gallbladder should be treated cholecystectomy and heterotopic pancreas should be in mind for the differential diagnosis of masses in the gallbladder.

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1) Harold KL, Sturdevant M, Matthews BD, Mishra G, Heniford BT. Ectopic pancreatic tissue presenting as submukozal gastric mass. J Laparoendosc Adv Surg Tech A 2002; 12:333-338.
2) Neupert G, Appel P, Braun S, Tonus C. Heteretopic pancreas in the gallbladder diagnosis, therapy and course of a rare developmental anomaly of the pancreas.Chirurg 2007; 78: 261-264.
3) Monig SP, Selzner M, Raab M, Eidt S. Heterotopic pancreas. A difficult diagnosis. Dig Dis Sci 1996; 41:1238-1240.
4) Ben-Baruch D, Sandbank Y, Wolloch Y. Heterotopic pancreatic tissue in the gallbladder. Acta Chir Scand 1986; 152:557-558.
5) Inceoglu R, Dosluoglu HH, Kullu S, Ahiskali R, Doslu FA. An unusual cause of hydropic gallbladder and biliary colicheterotopic pancreatic tissue in the cystic duct: Report of a case and review of the literature. Surg Today 1993; 23: 532-534.
6) Lai EC, Tompkins RK. Heterotopic pancreas. Review of a 26 year experience.Am J Surg 1986; 151:697-700.
7) Pilloni L, Cois A, Uccheddu A, Ambu R, Coni P, Faa G. Complete pancreatic heterotopia of gallbladder with hypertrophic duct simulating an adenomyoma. World J Gastroenterol 2006; 12:1786-1787.
8) Kondi-Paphiti A, Antoniou AG, Kotsis T, Polimeneas G. Abberant pancreas in the gallbladder wall.Eur Radiol 1997; 7:1064-1066.
9) Mboti F, Massarani F, De Keuleneer R. Cholecystitis associated with heterotopic pancreas.Acta Chir Belg 2003; 103:110-112.
10) Brown HW, Tabbah I. Aberrant pancreatic tissue in the wall of the gallbladder: Report of a case simulating gallstone disease. Int Surg 1979; 64:43-44.
11) Bhana BD, Chetty R. Heterotopic pancreas-an unusual cause of cholecystitis. S Afr Surg 1999; 37:105-107.
12) Jeong HY, Yang HW, Sco SW, Scong JK, Na BK, Lee BS, Song GS, Park HS, Lee HY.Adenocarsinoma arising from an ectopic pancreas in the stomach. Endoscopy 2002; 34: 1014- 1017.
13) Makhlouf HR, Almedia JL, Sobin LH. Carsinoma in jejunal pancreatic heterotopia. Arch Pathol Lab Med 1999; 123: 707- 711.