Ectopic pancreatic tissue in the small intestine: An uncommon finding following trauma

Introduction: Ectopic pancreatic tissue (EPT), also known as Heterotopic pancreas (HP), is a rare congenital anomaly characterized by the presence of pancreatic tissue outside the primary organ. This report presents a case of EPT incidentally discovered in the submucosal area of the small intestine.

Case presentation: A 56-year-old male presented to the emergency department following a high-speed car collision, reporting abdominal pain after impact with the steering wheel. Physical examination revealed left upper quadrant tenderness. Imaging studies showed free fluid in the abdominal and pelvic cavities, mesenteric damage, and increased intestinal wall thickness. Surgical exploration confirmed hemoperitoneum and a non-viable 30 cm segment of the small intestine, which was resected. Subsequent pathological examination revealed a 1.5 cm submucosal mass, diagnosed as EPT. The patient recovered uneventfully and was discharged in stable condition.

Clinical discussion: Clinically significant lesions are typically larger than 1.5 cm and involve the mucosa, with pain as the most common symptom. They can also cause severe complications such as intestinal obstruction, perforation, peritonitis, and gastrointestinal bleeding. Additionally, EPT can be associated with malignant transformations.

Conclusion: While often asymptomatic, EPT can lead to significant complications, making surgical resection essential for both symptomatic and incidental cases, particularly since diagnosis is frequently established postoperatively through histological examination. Although trauma may not directly cause EPT, its management in emergency settings can facilitate evaluations that reveal lesions capable of causing severe complications if left undiagnosed. Given the diverse symptoms associated with this condition, EPT should be considered in the differential diagnosis of intestinal lesions.