Introduction
Ectopic pancreas tissue (EPT) or pancreatic heterotopia is a rarely
observed congenital abnormality defined as the presence of pancreatic
tissue in another organ without any anatomical or vascular connection to
the pancreas. The term consists of the two Greek words ”hetero-” which
means ”other” and ”-topia” which means ”site”, pointing out the unique
location of pancreatic cells. EPT’s favored sites are the stomach,
duodenum, colon, jejunum, and Meckel’s diverticula (1). The gallbladder
is a highly infrequent location for EPT (2). Almost all cases are
detected incidentally during the histopathological examination after
cholecystectomy for other pathologies. The prevalence of EPT in the
gastrointestinal tract varies from 0.6% to 13.7% in autopsy series and
0.2% in laparotomies (3, 4). Although the malignant transformation of
this tissue is not frequently expected, pathologists must be aware of it
to ensure no malignant pathology is present and prevent further
misdiagnosis. In this study, we present a case of EPT that we found
incidentally during the histopathological examination of the specimen
from the gallbladder in a patient who underwent cholecystectomy due to
acute cholecystitis.
Case History
A 40-year-old male was referred to the emergency department for acute
pain in the right upper quadrant of the abdomen. The pain was constant
and initiated hours before and intensified when he had dinner. He also
reported fever, anorexia, nausea, and one involuntary vomiting episode
containing only stomach contents. Besides intellectual disability and
epilepsy, patient’s medical history was unremarkable otherwise. He was
on Valproate(200mg/D), Risperidone(1mg/BD) and Clonazepam(1mg/HS). He
denied smoking and any recreational drug use. No allergies were
reported. During the clinical examination, his vitals were slightly
above normal ranges (Blood pressure: 115/70mmHg; Heart rate: 108bpm;
Respiratory rate: 19 breaths/min; Temperature: 37.9°C; Oxygen
saturation: 99% without supplemental oxygen). The palpation of the
abdomen revealed tenderness in the right upper quadrant and a positive
Murphy sign with no rebound tenderness or guarding. The laboratory
evaluation was within normal range except for a WBC count of 10300, ESR
of 32, and a 2+ CRP. Additionally, he underwent an ultrasonographic
evaluation of the upper abdomen, reporting a thickened wall gallbladder
containing multiple stones (measuring up to 8x10mm). The patient was
scheduled for emergency laparoscopic cholecystectomy under the diagnosis
of acute calculous cholecystitis. During surgery, the gallbladder was
found to be gangrenous. The patient had a complicated postoperative
period due to surgical wound infections and was hospitalized for a week
to receive intravenous antibiotics; however, he did not report any
delayed complications or symptoms after discharge.