Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study
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In brief
In brief
Multi-center study of 88 pediatric patients with heterotopic pancreas found most cases asymptomatic and commonly located in Meckel's diverticulum (47%), frequently with gastric mucosa heterotopia. Surgical or endoscopic resection is recommended regardless of symptoms due to potential complications.
- Heterotopic pancreas in children is often asymptomatic (75% in this series), frequently discovered incidentally during evaluation for other conditions.
- Meckel's diverticulum is the most common location (47%), with 80% of these cases showing concurrent gastric mucosa heterotopia.
- Symptomatic presentation is more likely (75%) when heterotopic pancreas in Meckel's diverticulum occurs WITHOUT accompanying gastric mucosa heterotopia.
- Surgical or endoscopic resection is recommended even for asymptomatic cases due to risk of complications including obstruction, bleeding, and malignancy.
- Treatment approach (open, laparoscopic, or endoscopic) should be individualized based on patient age, lesion location and size, and coexisting pathology.
Written by the GCMD Library team from the article.
Abstract
Objective
Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients.
Methods
We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed.
Results
The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel’s diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel’s diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient’s age, the lesion site and size, and coexisting diseases.
Conclusions
Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel’s diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.