surgical slides

1. Sunday, May
14, 2023
1
Pancreatic rest
PROFESSOR DR. HIWA OMER AHMED
GENERAL AND BARIATRIC SURGERY

2. Sunday, May
14, 2023
2
Definition & inciedence
 Pancreatic rest, or aberrant, ectopic or heterotopic pancreas, is
a rare congenital anomaly.
 Pancreatic rests are benign congenital anomalies defined as
pancreatic tissue that lacks anatomic or vascular continuity with
the pancreas itself
 The incidence is 0.5–13% from autopsies.
 These masses are often found incidentally and asymptomatic.
 Masses are typically located in the stomach, duodenum and
jejunum

3. Sunday, May
14, 2023
3
Heterotopic
 Heterotopic pancreas was categorized by Heinrich in 1909 and
was modified by Gaspar-Fuentes in 1973.
1. Type I consists of tissue most resembling the pancreas
containing acini, ducts and Islet cells.
2. Type II contains only pancreatic ducts.
3. Type III resembles exocrine pancreas by containing acinar
tissue.
4. Type IV resembles endocrine pancreas as it contains only Islet
cells

4. Sunday, May
14, 2023
4
Symptomatic
 Symptoms are typically seen when the lesion is >1.5 cm, may cause
1. epigastric pain
2. Abd Discomfort
3. Nausea, vomiting
4. Bleeding
5. Obstruction
6. Pancreatitis
7. In Pediatric cases : intussusception , pancreatitis, abscess, pseudocyst
formation, fifteen cases have reported malignant transformation

5. Sunday, May
14, 2023
5
Other complications
 Ulcer formation
 Hemorrhage
 Mucosal erosions from enzyme release
 Intestinal or biliary symptoms from luminal obstruction by ectopic tissue

6. Sunday, May
14, 2023
6

7. Sunday, May
14, 2023
7

8. Sunday, May
14, 2023
8
 EUS should be performed prior to endoscopic mucosal resection to
ensure safety of resection by making sure the lesion is superficial, not
vascular, and does not involve the muscularis propria
 Standard forceps biopsy or snare polypectomy is often non-diagnostic due
to inadequate depth of sampling.

9. Sunday, May
14, 2023
9
Biopsy
 Tissue sampling to obtain a histological diagnosis may be beneficial in
excluding more serious entities
 DDx;
1. Lipomas
2. Inflammatory polyps
3. Hyperplastic mucosa
4. Cysts
5. Entities
6. Malignant potential such as carcinoid tumors and gastrointestinal stromal
tumors (GIST).