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April 7, 2008

Aches and Pains, Other Illnesses

Question from Brandon, Manitoba, Canada:

My 13-year-old daughter and has had diabetes for seven years. She was an extremely active child. She has been severely ill for the last three and a half months. She has had erratic blood sugars that are very difficult to control, is in constant pain in her abdomen, intermittent diarrhea and vomiting (worse after she eats). After tests and referral, a pediatric gastroenterologist found an ectopic pancreas by pylorus. A CT scan showed a bigger “mass” than the scope showed. We have been referred to a surgeon who we have not seen yet. My daughter has been put on 11 different drugs in the last three months, unfortunately, to no avail. This illness has had her in and out of hospital. She cannot attend school consistently or do any activity as pain increases. Do you have any information about ectopic pancreas? My understanding is this is something that does not usually cause pain and would have been there since birth, so any ideas on why her blood sugars, all of the sudden, are so erratic?

There is something the doctor has referred to as a “mass effect” located under the pancreatic tissue. It is my understanding they still do not know what this mass effect is. Could this ectopic pancreas be producing insulin? We continue to work with the medical professionals and I am confident we will get this resolved but, in the meantime, this has been the longest three months of our lives and to see a child’s body change so drastically, so quickly is very frustrating while we wait to find out the cause. Her gastric emptying test shows delayed gastric emptying. Any information would be greatly appreciated.


From: DTeam Staff

My understanding is that an ectopic pancreas is usually without symptoms. But, depending on where it is located, it may indeed cause symptoms. This could be the “mass effect” that was relayed to you. For example, if the extra, abnormally located “ectopic” pancreas is located within the stomach or next to other abdominal structures, you can get symptoms referable to that. I am aware of a case of pancreatic tissue identified within the pituitary gland in the brain; this tissue became cancerous. Furthermore, the literature describes ectopic pancreases that have bled or been inflamed. This is called “pancreatitis,” which can cause severe abdominal pain. Laboratory tests can help make that diagnosis. The pancreas is capable of producing several different hormones, so I would presume that an ectopic pancreas can produce insulin. But that insulin may be ineffective or have poor secretion regulation because the abnormal ectopic pancreas may not be linked to a proper blood supply.

I presume that your daughter also has her normal pancreas in place and the ectopic pancreas is not her sole pancreatic tissue. I also presume that your doctors have done a variety of special imaging and endoscopic techniques to better define the ectopic pancreas as perhaps a surgical approach to remove the abnormal tissue is being considered.