Pancreatic rest, also known as heterotopic pancreas, is a rare congenital anomaly where pancreatic tissue lacks continuity with the pancreas and is located elsewhere in the gastrointestinal tract. It occurs in 0.5-13% of autopsies, with masses typically found in the stomach, duodenum, and jejunum. Pancreatic rest is usually asymptomatic but can become symptomatic if the mass is larger than 1.5 cm, potentially causing pain, obstruction, bleeding, or pancreatitis. Tissue sampling through biopsy is needed to diagnose pancreatic rest and rule out other potential entities, as resection may be required if complications arise.

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Pancreatic rest
PROFESSOR DR. HIWA OMER AHMED
GENERAL AND BARIATRIC SURGERY

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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

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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

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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

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Other complications
 Ulcer formation
 Hemorrhage
 Mucosal erosions from enzyme release
 Intestinal or biliary symptoms from luminal obstruction by ectopic tissue

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 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.

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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).