The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 21 (page 99)

Ectopic Pancreatic Tissue

Samuel (l955) pointed out that barium-filled ducts in ectopic pancreatic tissue, embedded in the wall of the stomach, may simulate an intramural diverticulum. Moore and Kaplan (l956) found that a small mass of aberrant pancreatic tissue may be loosely attached to the serosal surface of the upper intestine, or it may occur in the subserosal, submuscular or submucosal regions of the gastric walls. Radiographically it usually presents as an elevated mound with a central dimpling and an opening formed by ducts. When the dimpling is filled with barium, it may resemble a polyp with an ulcer at its tip; when the ducts are filled, it resembles a diverticulum.

Besemann et al. (l97l) confirmed that most aberrant pancreatic nodules occurred in the upper gastrointestinal tract, usually in the duodenum, but occasionally in the stomach near the pylorus.

Case Report

Case 21.1. D.J., 22 year old male, had a long history of dyspepsia not responding to anti-ulcer treatment. Two days before admission there had been an episode of haematemesis. Gastroscopy showed a small orifice on the posterior gastric wall close to the pyloric aperture. It was thought to be either an intramural diverticulum or a double pylorus; radiographic examination was requested for further elucidation. This showed a small, branching, diverticular structure approximately 1.0 cm in length, on the greater curvature side of the pyloric sphincteric cylinder within 1.0 cm of the pylorus (Fig. 21.1). It remained constant in appearance irrespective of the degree of contraction of the cylinder, the contractions being normal. At laparotomy no evidence of ulceration was seen. A nodule of abnormal tissue measuring approximately 2.0 cm in diameter was palpated in the gastric wall at the site indicated by endoscopy and radiology. Gastrostomy revealed a small orifice extending into the nodule, which was removed by local excision. Histology showed it to consist of endo- and exocrine pancreatic tissue located in the muscular coat of the stomach.

Fig. 21.1. Case D.J. Small, branching, diverticulum-like structure (arrow) on greater curvature side of pyloric sphincteric cylinder


In this case a small nodule of ectopic pancreatic tissue in the wall of the greater curvature of the pyloric sphincteric cylinder did not affect the movements of the cylinder to any appreciable extent. Radiographically the lesion mimicked an intramural diverticulum (Chap. 22).


  1. Besemann EF, Auerbach SH, Wolfe WW. Importance of roentgenologic diagnosis of aberrant pancreatic tissue in the gastrointestinal tract. Amer J Roentg Rad Ther Nucl Med l969, 107, 71-76.
  2. Moore MB, Kaplan IW. Heterotopic pancreatic tissue in the stomach. Amer J Gastroenterol l956, 26, 699-705.
  3. Samuel E. Gastric diverticula. Brit J Radiol l955, 28, 574-578.

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