Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis
An 18-year-old girl, after two months of normal vaginal delivery, presented with a history of right upper quadrant abdominal pain for two months, associated with vomiting off and on. Upon general examination, she was afebrile, normotensive, and had no jaundice. Per abdominal examination, she showed tenderness in the right hypochondrium. Routine blood investigations revealed no abnormality. Her Liver Function Tests showed normal serum bilirubin of 0.40 mg/ dL (0.20- 0.80), serum ALT of 35.0 U / L (7-41), serum AST of 43.0 U/L (12-38), and serum alkaline phosphatase of 110.0 U/L (33-96).\nUltrasonographic examination of the whole abdomen showed no abnormality, except for cholelithiasis. Laparoscopic cholecystectomy was done. On gross examination, the gallbladder measured 8 cm in length and 2.5 cm in circumference, with a wall thickness ranging from 0.2 to 0.4 cm. The serosa was unremarkable. On cutting open, the mucosa was velvety flattened and focally ulcerated. Eight yellowish-green friable round stones, each measuring 0.6 cm in diameter, were noted in the fundus. A whitish area was seen in the neck region, which on microscopic examination, showed a well-circumscribed rest of heterotopic pancreatic tissue beneath the muscularis layer, composed of lobules of exocrine pancreatic acini and an occasional duct [Figures and ]. Islets of Langerhans were not seen. The remaining sections showed features of chronic cholecystitis.