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Description

Ectopic pancreas (EP), also referred to as heterotopic pancreas, is defined as pancreatic tissue located outside the normal pancreas without anatomic or vascular continuity to the gland. Prevalence is 1-2% based on autopsy reports. EP is thought to result from aberrant migration of pancreatic tissue during embryonic foregut rotation and the stomach accounts for 24-38% of cases. Other common locations for EP include the duodenum and upper jejunum. While most cases are asymptomatic, complications can include ulceration, pseudocyst formation, pancreatitis, gastric outlet obstruction (GOO), or rarely malignant transformation. GOO caused by EP is especially rare with only a limited number of cases reported in the literature.

We report a case of a 67-year-old man who presented with progressive GOO from EP with pseudocyst formation, ultimately requiring surgical resection. He presented with several months of epigastric abdominal pain, nausea, vomiting, constipation, and bloating. Initial EGD revealed localized abnormal antral mucosa; biopsy showed gastric antral-type mucosa with features of foveolar hyperplasia. Two months later, he presented with recurrent pain, 25-pound weight loss, and an inability to tolerate oral intake. CT at this time revealed circumferential gastric pyloric wall thickening (2.6 cm) with perigastric fat stranding. Repeat EGD with EUS revealed a 40 x 22 mm intramural mixed solid/cystic antral lesion extending to the pylorus causing a partial GOO. FNA revealed atypical glandular cells.

Management of gastric EP depends on symptoms and degree of suspicion for malignancy. Asymptomatic lesions can be monitored, while resection is recommended for lesions > 3 cm, with concerning EUS features, or complications such as bleeding or obstruction. EP is an uncommon cause of GOO that should be included in the differential diagnosis of gastric submucosal lesions. Awareness of characteristic imaging and endoscopic features may raise suspicion and surgical resection is both diagnostic and therapeutic in symptomatic cases.

Publication Date

5-8-2026

Disciplines

Surgery

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2075

An Unlikely Culprit: Gastric Outlet Obstruction from an Ectopic Pancreatic Pseudocyst

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