A rare case of heterotopic pancreatitis and intestinal malrotation in a COVID-19 positive patient. COVID-19, causative or coincidence?

• Published in: International journal of surgery case reports 2021-05, Vol.82, p.105917, Article 105917
• Main Authors: Tomasi, Ivan, Scott, Luca, Cullen, Jack, di Maggio, Francesco, Ebied, Husam, Wheatstone, Sarah
• Format: Article
• Language: English
• Subjects: Case Report; COVID-19; Heterotopic pancreatitis
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.105917

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. 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. 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. 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. •Heterotopic pancreas can be present in up to 13.7% of patients.•Heterotopic pancreatitis is a rare complication.•Pre-operative diagnosis of heterotopic pancreatitis is difficult.•COVID-19 can induce pancreatic injury and potentially acute pancreatitis.•COVID-19 may have contributed to the heterotopic pancreatitis in our patient.