Concomitant Heterotopic Pancreas and Endometriosis as a Rare Cause of Ileo-Ileal Intussusception in a Young Woman with S
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Concomitant Heterotopic Pancreas and Endometriosis as a Rare Cause of Ileo‑Ileal Intussusception in a Young Woman with Spina Bifida: Case Report and Literature Review A. Sciannamea1 · S. Vaccari2 · G. Marasco3 · B. Dalla Via1 · A. Lauro1 · I. R. Marino4 · F. Vasuri5 · M. Cervellera1 · V. D’Andrea2 · V. Tonini1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Isolated heterotopic pancreas (HP) as the primary cause of bowel intussusception is extremely rare. We report a case of a 33-year-old female patient with spina bifida admitted to the Emergency Surgical Department for ileal intussusception due to the presence of heterotopic pancreas associated with endometriosis. Areas Covered Symptomatic ileal intussusception for ectopic pancreas is usually associated with overt gastrointestinal blood loss (predominantly melena), abdominal pain, vomiting, and weight loss. Treatment is universally surgical. Expert Commentary Isolated heterotopic pancreas is a rare condition; it should be considered in the differential diagnosis of bowel intussusception. Keywords Heterotopic pancreas · Abdominal pain · Spina bifida · Endometriosis · Bowel Intussusception Abbreviations CT Computed tomography EGDS Esophago-gastro-duodenal endoscopy Hb Hemoglobin WB White blood cells CRP C-reactive protein HP Heterotopic pancreas
* A. Lauro [email protected] 1
Emergency Surgical Department, St. Orsola University Hospital, Bologna, Italy
2
Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
3
Department of Medical and Surgical Sciences, St. Orsola University Hospital, Bologna, Italy
4
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
5
Department of Experimental Diagnostic and Specialty Medicine, Institute of Oncology and Transplant Pathology, St. Orsola University Hospital, Bologna, Italy
Case Report and Evolution A 33-year-old female patient was initially admitted to the Emergency Department and later to the Gastroenterology Unit at S. Orsola University Hospital in Bologna for abdominal pain associated with vomiting, without fever or altered bowel habits. Over the previous 3 months, she was evaluated twice for abdominal pain, vomiting and progressive weight loss (up to 5 kg). EGD revealed signs of chronic gastritis without Helicobacter pylori; laboratory tests and abdominal X-rays were negative, and a diagnosis of “irritable colon” was made. There were no relevant comorbidities apart from spina bifida. At admission, the patient complained of abdominal pain without signs of peritonitis. Blood tests showed anemia (Hb 11.8 g/dL), WBC 17.2/µL (87% neutrophils) with normal CRP (0.03 mg/dL). She was moved to the Gastroenterology Unit where intestinal infectious diseases were excluded. An ultrasound examination of the abdomen revealed wall thickening of the terminal ileum, caecum, and appendix associated with multiple inflammatory lymph nodes, effusions, and mesenteric thickening. Abdominal
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