Diabetes

Aberrant pancreas: what is it?

Aberrant pancreas is an abnormal development of the digestive system.

This pathology manifests itself by the development of tissues similar in structure to the pancreatic gland in the area of ​​the gastric mucosa, duodenum or near the pancreas itself.

Disorders of development occur at the stage of embryogenesis, when there is a laying and the formation of organs.

Among the causes of the aberrant gland are distinguished:

  • genetic predisposition;
  • the impact on the fetus of bad habits of the mother;
  • infectious diseases (measles, rubella);
  • radiation exposure;
  • certain pharmacological drugs.

Aberrant pancreas is not a disease, but can also be subject to the development of inflammation and destruction, it can squeeze adjacent organs and thus manifest itself.

Such an abnormal gland in structure corresponds to the normal one, has its own aberous pancreatic duct, which opens into the intestinal lumen.

Aberrant pancreas is defined as pancreatic tissue that does not have anatomical and vascular continuity with the main body of the pancreas. The most frequent heterotopia of the pancreas is localized in the stomach, the excretory duct most often flows into the ventral division.

Most patients with gastro-aberrant pancreas are asymptomatic. They rarely come with clinical symptoms, such as abdominal pain and bleeding. Several cases of aberrant pancreatic gland complicated by acute inflammation, such as pancreatitis, have been reported.

Ectopia of the pancreas is mostly detected by chance, during the search for lesions of the gastric mucosa, since the clinic corresponds to acute gastritis. Thus, the aberrant segment of the pancreas provokes the clinical picture and the corresponding symptoms, depending on the location and on its own dimensions.

Dystopia can be localized:

  • in the gastric wall;
  • in the sections of the duodenum;
  • in the departments of the ileum, in the tissues of the diverticulum;
  • in the thickness of the omentum small intestine;
  • in the spleen;
  • in the gallbladder.

Characteristic clinical picture

Ectopic pancreatic gland can be located in different departments.

If it is located at the junction of the stomach and duodenum, then it gives a clinical picture resembling a duodenal ulcer.

There is pain in the epigastric region, nausea, bleeding may occur.

In addition, the clinical picture with this arrangement of the ectopic pancreatic gland may resemble:

  1. Cholecystitis - pain in the right hypochondrium, jaundice, itchy skin.
  2. Appendicitis - pain in the upper abdomen or the right iliac region, nausea, disposable vomiting.
  3. Pancreatitis - shingles pain more in the upper left half of the abdomen.

With localization in the stomach, the clinic is similar:

  • with a stomach ulcer.
  • with pancreatitis.

Acute pancreatitis that occurs in the gastrointestinal aberrant gland is rare, and one of its main symptoms is abdominal pain. In almost all cases, a slight increase in serum amylase is observed.

Consequently, acute or chronic pancreatitis caused in the aberrant pancreas may occur due to obstruction of the ducts, but not from direct cell damage caused by the use of heavy alcoholic beverages.

Dangerous symptoms in the involvement of the aberrant pancreas in the pathological process:

  1. Necrosis of the ectopic organ;
  2. Violation of the integrity of the walls of the hollow organ;
  3. Bleeding, vascular damage to the gland.
  4. Development of intestinal obstruction due to obstruction of the aberrant pancreatic intestinal lumen.

Most often, these serious complications occur when the submucosa or subserous localization of additional glandular tissue in the small intestine, the lumen in this section is quite narrow. The result is a rapid development of obstruction.

The first symptoms in the development of inflammation in the ectopic organ are:

  • disorders of the digestive system;
  • pain after eating and hunger pains;
  • violation of the passage of food, accompanied by nausea and vomiting.

Since the symptoms are common and can correspond to a huge number of diseases of the gastrointestinal tract, instrumental and laboratory diagnostics are indispensable.

Diagnosis of the pathological condition

Ectopia of this organ is not difficult to diagnose, but it can hide behind masks of other diseases.

You can visualize education using some instrumental methods.

The following examination methods are used to identify pathology:

  1. X-ray of the abdominal cavity allows you to see the protrusion of the mucous membrane with the accumulation of contrast in this area.
  2. Fibrogastroduodenoscopy - the presence of a seal area of ​​the mucous membrane, on the surface of which there is a depression - the place of exit of the aberrant duct.
  3. Ultrasound examination of the abdominal cavity, the study is based on the different echogenicity of the pancreatic duct and pancreatic tissue itself.
  4. Computed tomography well shows the pathology, but there is a need to differentiate it from tumor processes, in this regard, to confirm the diagnosis during fibrogastroduodenoscopy, a biopsy of the formation is performed with further histological examination.

The aberrant gland can be divided into three types of histology.

Type I has a typical tissue having a lobular structure, with the presence of a duct and islets resembling cells of a normal pancreas;

Type II contains pancreatic tissue with numerous acini and several ducts devoid of islet cells;

Type III, in which only the excretory ducts are observed.

Therefore, aberrant pancreas (especially types I and II) can demonstrate the full range of pancreatic pathologies, including pancreatitis (acute and chronic), as well as benign and malignant neoplastic transformations.

Treatment of organ pathology

It remains controversial whether acute or chronic inflammatory changes in the aberrant pancreas are caused by similar pathological processes that provoke pancreatitis in the anatomical pancreas.

An ectopic organ can often remain in the shadow of a lifetime, but if it is a pathological process, then the most successful method of treatment is surgical.

At the moment, they also use the drug method of treatment with analogues of somatostatin - the pituitary hormone, the therapy is symptomatic and does not contribute to the reduction of intestinal stenosis.

Now surgeons tend to the least traumatic operations, and in the case of the aberrant pancreatic gland, minimally invasive endoscopic techniques or surgical interventions are used:

  1. The operation of microlaparotomy with the formation of an anastomosis between the anatomical and aberrant glands - this allows you to avoid the development of inflammation of the ectopic organ.
  2. If the pancreas is located in the wall of the antrum of the stomach, where it most often has the form of polypous proliferation, endoscopic electroscission is used.

Thus, the formation is removed without traumatic damage to the mucous membrane, and with minimal blood loss.

In the case of such surgical interventions, the patient after two or three days may go home.

About the symptoms of diseases of the pancreas described in the video in this article.

Watch the video: Endoscopy of Heterotopic Pancreas (September 2019).