Aberrant pancreas
term "aberrant" means surplus. Such pancreas refers to abnormal cases of development and can be located in the wall of the stomach, duodenum, small intestine or in the diverticulum of the ileum.
It should be noted that there is no connection with the normal pancreas at the additional pancreas. The aberrant pancreas has its own characteristics, which require a definite approach both in diagnosis and in treatment. Therefore, it is necessary to dwell on these issues separately and consider them in detail.
Diagnosis
The detection of an abnormal pancreas depends largely on its localization. If it is located in the wall of the duodenum, stomach or large intestine, then in this case the diagnosis, as a rule, does not cause difficulties. Most often, its detection occurs randomly during a screening survey, with the age of patients with such an anomaly, usually between 40 and 70 years.
This abnormality can be detected using various methods of :
- Endoscopic. This gland looks like a large islet of glandular tissue, often having the appearance of a polyp and located on a wide base. Often at the top of such a polyp may be an impression that is an endoscopic sign of the aberrant gland. If a surface biopsy is taken during an endoscopic examination, then it may not be sufficiently informative.
- Radiological. Abnormal gland in this case can be visualized as a sufficiently large formation, which is noticeable in the form of a cluster of contrast medium. In this case, the presence of a duct of the extra gland can be noted( it is also contrasted).
- Ultrasound examination. It is possible to notice additional pancreas in UZ-diagnostics, in this will help the characteristic signs - the hypoechoic structure of formation, the presence of additional cavities( not always revealed), as well as anehogenous duct of the gland.
- Computed tomography of abdominal organs. Using this method of diagnosis, it is possible to detect formation if it is located in the wall of a hollow organ. This method also allows differential diagnosis of malignant tumors. In the case of cancer, there is invasion of the tumor into adjacent abdominal organs and metastases. Differential diagnostics with submucosal tumors( leiomyoma, lipoma, myosarcoma) may be difficult.
Symptoms
Clinical manifestations in the presence of an aberrant gland are largely dependent on its location and size. If it is located in the wall of the stomach, the symptoms can be masked for gastritis, if the additional gland is located in the area of the duodenum, then there may be symptoms inherent in peptic ulcer. Also, manifestations of cholecystitis, pancreatitis or appendicitis are possible.
But most often no symptoms are noted, and complaints only appear if complications develop. Among them are the following:
- inflammation;
- Perforation of the intestinal or gastric wall;
- necrosis;
- bleeding;
- intestinal obstruction.
The most common complications occur if the aberrant gland is located in the wall of the small intestine. In this case, develops small intestinal obstruction.
If inflammation occurs in the extra gland, dyspeptic disorders, abdominal pain, may occur. In laboratory examination, transient hyperlipazemia, hyperamilazemia can be detected. In the analysis of urine there is an increased content of amylase - hyperamylasuria.
Treatment of
If an additional pancreas is detected, a surgical operation can be performed, the volume of which will depend on the clinical manifestations, the location of the gland and its size. A mandatory histological examination is recommended, even if there are no clinical symptoms. Such timely diagnostics will help to exclude the presence of malignant formation.
The most effective method of treatment is a mini-laparotomy with endoscopic support or laparoscopy. In this case, anastomoses are often performed around the narrowed section. It is not recommended to remove the aberrant gland or its site, as this can lead to the development of inflammation or the appearance of a fistula.
If the additional gland is located in the wall of the stomach or duodenum and thus has the appearance of a polyp, then it is possible to perform endoscopic electroexcision. If large cysts are present in the aberrant gland, endoscopic fenestration of the cysts may be effective. But it can be carried out only with a small number of cysts and their large size.
As you can see, the diagnosis of an additional pancreas can often be difficult, because the clinical manifestations are different, and sometimes they are absent. Treatment of the aberrant gland also presents difficulties and should be carried out taking into account the severity of the symptoms.
