Pancreatic Ectopia

　　The cause of ectopic pancreas is related to abnormal embryonic development. At the 6th to 7th week of human embryonic development, when the dorsal and ventral pancreatic primordia rotate and fuse with the superior part of the primitive gut, if one or more primordial pancreatic cells remain in the primitive gut wall, due to the longitudinal growth of the primitive gut, the primordial pancreas can be carried away. The cell tissue produced by the dorsal pancreatic primordia will be carried to the stomach; the ventral primordial pancreas will be carried to the jejunum, becoming an ectopic pancreas. If the primordial pancreas extends into the gastrointestinal wall, biliary system, omentum, or even spleen, pancreatic tissue will appear in these organs, which is also considered an ectopic pancreas.

　　Common complications include: acute pancreatitis, chronic pancreatitis, cysts, adenomas, adenocarcinomas, and others. Ectopic pancreas located around the duodenal papilla can cause obstructive jaundice; located in the small intestine, especially at the end of the ileum, can induce intussusception, causing corresponding symptoms; located in the gallbladder, gallbladder imaging can show filling defects on the gallbladder wall, which are fixed, and gallstones can move, but it is difficult to distinguish from benign tumors of the gallbladder wall. Ectopic pancreas, stimulated by digestive juices, secretes proteases, causing inflammation and tissue damage around, erosion, and hemorrhage due to erosion of gastrointestinal mucosal blood vessels, thus symptoms such as abdominal pain and 'tarry' stools may occur.

　　Ectopic pancreas usually has no clinical symptoms and can be found incidentally during surgery or autopsy. Due to growth in certain special locations or other pathological changes, the following six clinical manifestations may occur, and some people also call them six types:

　　1, Obstructive type

　　An ectopic pancreas growing in the digestive tract can cause compression or stenosis of the organ in which it grows, resulting in obstruction symptoms, such as pyloric stenosis if located in the antrum of the stomach; biliary obstruction if located in the ampulla of Vater; intestinal obstruction or intussusception if located in the intestine.

　　2, Hemorrhagic type

　　Ectopic pancreas is prone to cause gastrointestinal bleeding, and the cause may be due to congestion, erosion, or erosion of gastrointestinal mucosal blood vessels around the ectopic pancreas, leading to gastrointestinal bleeding.

　　3, Ulcerative type

　　Ectopic pancreas located in the gastrointestinal tract can secrete trypsin due to stimulation by digestive juices, digesting the gastric and intestinal mucosa to form ulcers; ectopic pancreas located beneath the mucosa can compress the upper mucosa, causing mucosal atrophy, and then ulcers occur.

　　4, Tumor type

　　If an ectopic pancreas is located in the submucosal layer of the gastrointestinal tract, it can cause local bulging of the mucosa; if located in the muscular layer, it can thicken the gastric wall or intestinal wall, and is easily misdiagnosed as a gastrointestinal tumor. Occasionally, ectopic pancreas tissue may develop into an insulinoma, causing hypoglycemia; malignant transformation will then show symptoms of pancreatic cancer.

　　5, Diverticular type

　　Abnormal pancreas tissue can be located in congenital diverticula of the gastrointestinal tract, especially in the Meckel diverticula, and can also cause symptoms such as diverticulitis, hemorrhage, and others.

　　6. Hidden type

　　Since ectopic pancreas is a congenital developmental abnormality, some cases may have no symptoms throughout their lives, or they may be found incidentally during surgery or autopsy.

　　When the pathological changes of ectopic pancreas are accompanied by obvious symptoms, surgical treatment should be performed, such as subtotal gastrectomy, intestinal resection, and diverticulectomy, etc. For those with smaller lesions, partial resection of the gastric wall or intestinal wall can be performed, followed by suture of the gastric wall or intestinal tract. It is strictly forbidden to attempt to simply peel off the ectopic pancreas tissue from the gastric or intestinal wall. If ectopic pancreas is occasionally found during other surgeries, and the patient has no symptoms caused by ectopic pancreas before surgery, it should be removed simultaneously as much as possible if it does not affect the original surgery and the resection of the ectopic pancreas is not difficult. Frozen sections should also be performed during surgery, and if there is cancer, the resection range should be expanded or radical surgery should be performed.

　　Abdominal Ultrasound:Ultrasound can clearly show the cross-sectional images of various organs and surrounding organs. Due to the rich sense of reality of the images, they are close to the true structure of anatomy, so ultrasound can be used for early and clear diagnosis.

　　1. Eat a light diet and pay attention to dietary balance.

　　2. Avoid spicy and刺激性 foods and seasonings, do not eat indigestible foods, such as: glutinous rice, persimmons, oranges, hard-shelled nuts (such as peanuts, walnuts, or cashews), etc. Leafy vegetables and fruits should be cut into fine pieces before eating. It should be avoided to consume too much high-sugar foods, such as sweet potatoes and potatoes. And high-sugar liquid foods, such as milkshakes, ice cream, etc.

　　When the pathological changes of ectopic pancreas are accompanied by obvious symptoms, surgical treatment should be performed. This may include subtotal gastrectomy, intestinal resection, and diverticulectomy, etc. For those with smaller lesions, partial resection of the gastric wall or intestinal wall can be performed, followed by suture of the gastric wall or intestinal tract. It is strictly forbidden to attempt to simply peel off the ectopic pancreas tissue from the gastric or intestinal wall. If ectopic pancreas is occasionally found during other surgeries, and the patient has no symptoms caused by ectopic pancreas before surgery, it should be removed simultaneously as much as possible if it does not affect the original surgery and the resection of the ectopic pancreas is not difficult. Frozen sections should also be performed during surgery, and if there is cancer, the resection range should be expanded or radical surgery should be performed.