Asian Journal of Case Reports in Surgery

Aims: Heterotopic pancreas (HP) is a rare congenital anomaly in which pancreatic tissue is present without anatomical or vascular continuity with the main gland. This case report describes the incidental identification of an antral HP in a 40-year-old male who had previously undergone laparoscopic sleeve gastrectomy (LSG), and it highlights the surgical implications of recognising this lesion during bariatric assessment.

Presentation of Case: The patient had a history of grade II obesity and underwent LSG 14 months before the current evaluation. During the preoperative work-up, an external oesophagogastroduodenoscopy described a small antral lesion as a simple polyp, and superficial biopsy showed only normal gastric mucosa. At routine 14-month postoperative surveillance, the patient remained asymptomatic, with no abdominal pain, dyspepsia, or gastrointestinal bleeding. Follow-up endoscopy showed a well-healed gastric sleeve and a prominent 2 cm vulcaniform subepithelial lesion in the distal gastric antrum, with central umbilication consistent with HP.

Discussion: The clinical relevance of this finding is related to the risk of inadvertent stapling across ectopic pancreatic tissue during LSG. Such an event may compromise staple closure and may contribute to staple-line failure, gastric fistula, postoperative haemorrhage, or traumatic pancreatitis of the heterotopic rest. Endoscopic ultrasound and computed tomography were discussed as confirmatory investigations; however, because the patient was asymptomatic and wished to avoid additional financial burden, conservative multidisciplinary surveillance was selected.

Conclusion: Recognition of the characteristic volcano-like appearance of antral HP is important during bariatric endoscopic evaluation. Careful preoperative identification may support safe surgical planning and reduce the risk of avoidable complications.