A rare case of heterotopic pancreatitis and intestinal malrotation in a COVID-19 positive patient. COVID-19, causative or coincidence?
| Autor: | Husam Ebied, Jack Cullen, Sarah Wheatstone, Luca Scott, Ivan Tomasi, Francesco Di Maggio |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
MRI Magnetic resonance imaging HP Heterotopic pancreas Case Report Anastomosis Gastroenterology Asymptomatic 03 medical and health sciences 0302 clinical medicine ED Emergency department ACE2 Angiotensin-converting enzyme 2 Internal medicine medicine Fat necrosis DJ Duodeno-jejunal PPE Personal protective equipment COVID-19 Coronavirus disease 2019 NEWS2 National early warning score 2 business.industry COVID-19 medicine.disease medicine.anatomical_structure AGPs Aerosol generating procedures Intestinal malrotation 030220 oncology & carcinogenesis CT Computed tomography Acute pancreatitis Pancreatitis SARS-CoV-2 Severe acute respiratory syndrome corona virus 2 030211 gastroenterology & hepatology Surgery Presentation (obstetrics) medicine.symptom business Pancreas Heterotopic pancreatitis |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2021.105917 |
| Popis: | Introduction and importance Heterotopic pancreas (HP) is defined as the presence of pancreatic tissue without anatomical and vascular continuity with the main body of the pancreas. HP typically remains asymptomatic, however complications such as acute pancreatitis can arise. Gastrointestinal involvement with coronavirus disease 2019 (COVID-19) is not uncommon and there are reported cases of associated pancreatitis. Case presentation A 31-year-old male presented to the Emergency department (ED) with a 3-day history of right iliac fossa pain. The patient was found to have COVID-19 and a planned laparoscopic appendectomy was later converted to a midline laparotomy when a mass close to the duodeno-jejunal (DJ) flexure was identified. Following a hand-sewn anastomosis the patient made a good post-operative recovery. Histology illustrated the presence of heterotopic pancreatic tissue within the small bowel with underlying fat necrosis typical of acute pancreatitis. Follow-up radiology supported the intraoperative finding of intestinal malrotation. Clinical discussion Rarely the combined presence of intestinal malrotation and HP in patients has been noted. Heterotopic pancreatitis can present in a multitude of ways and it is a difficult diagnosis to make pre-operatively. Emerging literature documents the potential presentation of COVID-19 with acute pancreatitis. The expression of angiotensin-converting enzyme 2 (ACE2) receptors on the pancreas is believed to play a role. Conclusion This is the first documented case of heterotopic pancreatitis with intestinal malrotation in a COVID-19 positive patient. We hypothesise that the COVID-19 infection contributed to the heterotopic pancreatitis. |
| Databáze: | OpenAIRE |
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