{'fraction_non_alphanumeric': 0.026381909547738693, 'fraction_numerical': 0.0041876046901172526, 'mean_word_length': 5.3537234042553195, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Gastrointestinal: Aberrant ileal pancreas causing intussusception

An aberrant pancreas or pancreatic rest is an isolated mass of pancreatic tissue that is separate from the normal pancreas. The aberrant tissue has been assumed to be a congenital anomaly, particularly as clinical syndromes have been described early in life. The most common site for an aberrant pancreas is the antrum of the stomach (70%). However, several other sites have been described including duodenum, jejunum, ileum, Meckel’s diverticulum, appendix and omentum. In addition, small foci of pancreatic tissue have been described in portal tracts in approximately 4% of human livers. Most aberrant pancreatic nodules are small (<1 cm) and are highly unlikely to be responsible for symptoms. However, larger nodules can occur and have been associated with bleeding, intussusception and intestinal obstruction. There have also been rare cases of pancreatitis and pancreatic cancer arising from aberrant tissue. At histology, operative specimens contain exocrine glands and excretory ducts, sometimes with islets of Langerhans (50%). The typical endoscopic appearance is a uniform submucosal nodule with central umbilication but no ulceration. The differential diagnosis can include stromal tumors, carcinoid tumors, nodular gastritis, carcinomas and lymphomas. Superficial endoscopic biopsies are rarely diagnostic but deep biopsies can reveal pancreatic tissue. Surgical resection is usually restricted to lesions that are large and symptomatic or to lesions where the preoperative diagnosis remains unclear. In the infant illustrated below, aberrant pancreatic tissue in the ileum resulted in intussusception. A 3-year-old child was evaluated in the Emergency Service because of a 3 day history of abdominal pain and vomiting. Abdominal examination revealed a tender lump in the right iliac fossa. A plain abdominal radiograph showed features of a small bowel obstruction. An abdominal ultrasound study showed a complex solid-cystic lesion in the right iliac fossa (Fig. 1). In a second image, there were features of intussusception with a solid lesion (arrow) as a lead-point (Fig. 2). At laparotomy, an ileo-cecal intussusception was found that contained a polyp and the patient was treated with a short ileal resection. Histological evaluation showed that the polyp was composed of heterotopic pancreatic tissue.