Introduction: Ectopic pancreas, characterized by pancreatic tissue outside its normal location without vascular or anatomic connection with the pancreas, is a rare congenital anomaly. While typically found in the stomach, occurrences in the jejunum or duodenum are infrequent. These benign lesions seldom necessitate intervention unless complications or symptoms arise, which are often nonspecific and location dependent. Herein, we detail a case of an ectopic pancreatic mass in the minor ampulla, diagnosed via biopsy and subsequent pathologic assessment of a 1.5 cm mass.
Case Description/Methods: A 69-year-old male with a history of asthma and BPH presented with new-onset left-sided abdominal pain, prompting imaging studies that were suggestive of choledocholithiasis. Laboratory tests, including liver enzymes, were within normal limits. Further evaluation via Endoscopic Ultrasound (EUS) revealed a slightly dilated common hepatic duct and a 1.5cm x 1.5cm exophytic mass in the minor ampulla. Biopsy and subsequent pathological evaluation were pursued due to concerns of malignancy. ECRP confirmed an 11mm common hepatic duct and a 6mm common bile duct, with sludge in the distal common bile duct necessitating sludge extraction and CBD stent placement. Post-procedure recovery was uneventful, and pathology revealed benign pancreatic parenchyma. Consequently, a potentially major surgical intervention was avoided in our patient.
Discussion: Ectopic pancreas, although rare, warrants consideration when assessing subepithelial ampullary lesions. Comprehensive histopathological evaluation and close monitoring can spare patients from invasive surgical procedures such as pancreaticoduodenectomy or ampullectomy. This case underscores the importance of precise diagnosis and tailored management in mitigating unnecessary morbidity and ensuring optimal patient outcomes.
Figure: Figure 1. (A) Endoscopic view of the exophytic mass in the minor ampulla. (B) MRCP showing dilatation of common hepatic and bile duct.
Disclosures:
Shriya Vudari indicated no relevant financial relationships.
Prajwal Kumsi Sreedhar indicated no relevant financial relationships.
Sarmand Jameel indicated no relevant financial relationships.
Sathya Jaganmohan indicated no relevant financial relationships.
Shriya Vudari, MD1, Prajwal Kumsi Sreedhar, MD1, Sarmand Jameel, MD1, Sathya Jaganmohan, MD2. P1892 - A Case of Ectopic Pancreas in the Minor Ampulla: Insights into Diagnosis and Management, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
