Surgical paper XIIX
Subcutaneous heterotopic pancreas of the abdominal wall
A Case Report
Heterotopic pancreas is typically documented to occur only in internal organs, most commonly beneath the mucosa of the digestive tract. Clinically, it is rare to encounter. To date, there have been no reported cases of heterotopic pancreas located subcutaneously in the abdominal wall. We treated a case in our hospital, which was pathologically confirmed post-surgical resection. We present the report below.
The patient is a 41-year-old male teacher admitted to our hospital on March 24, 1979, with the medical record number 794.
Approximately one year prior, he had a mass removed from his left lower abdomen at Hospital X. The pathological report identified the mass as a “desmoid tumor.” Ten months post-surgery, a recurrent mass the size of a fingertip appeared at the same site, which was asymptomatic. In the past week, the mass suddenly enlarged to the size of an egg and became tender to touch.
On examination, the patient’s general condition was normal, with no swollen superficial lymph nodes. A 5 cm oblique surgical scar was observed in the left lower abdomen. Below the scar, a 5x4x3 cm nodular, soft mass was palpable, with limited mobility and mild tenderness. There was no erythema or warmth. The white blood cell count was 5600/mm³, with 58% neutrophils and 42% lymphocytes.
Surgery was performed under local anesthesia immediately upon admission. The mass was located subcutaneously and above the muscle fascia. The boundary was ill-defined, and there was no capsule. The mass was lobulated and yellow in color. A sharp dissection was performed to excise the mass, followed by 24-hour subcutaneous drainage. The incision healed primarily, and the patient was discharged after a 9-day hospital stay. The pathological report confirmed “Heterotopic Pancreas in the Abdominal Wall’s Fibrous Tissue” (Pathology No. 4686).
One week after discharge, the patient experienced subcutaneous swelling, pain, and fluctuation, although there was no redness or fever. Antibiotic treatment was administered by the local community hospital, leading to gradual resolution of the symptoms without the need for fluid aspiration. The patient returned to normal within a month.
Originally published in "Nanling Medical Journal" by Li Mingjie & He Jinxian, Department of Surgery, Nanling County Hospital, 1979; 1:70