A Case of Ectopic Pancreas Presenting as Small Bowel Obstruction

Abstract

Ectopic pancreas is a congenital anomaly in which pancreatic tissue lacks anatomical or vascular continuity with the pancreas, most commonly found in the stomach. The majority of the cases have been found incidentally during laparotomy performed for other abdominal diseases, however they can present with vague symptoms such as nausea, abdominal pain or fullness. Ectopic pancreas causing intussusception is an extremely rare condition with very few cases having been described. A 37 year old male with no significant past medical history was admitted with abdominal pain, nausea and vomiting. Computed tomography(CT) scan showed non-obstructing bowel intussusception in left upper quadrant(See Figure 1). After failing conservative management for small bowel obstruction, he underwent exploratory laparotomy, segmental small bowel resection and anastomosis. Pathology showed a nodular mass measuring 1.5 centimeters(cm) x 1.5 cm x 1.0 cm within the muscularis-propria of the resected small bowel. The overlying small bowel mucosa was normal without any pathological alteration. The patient recovered from his surgery and was discharged home. A few weeks later, he presented with recurrent nausea and vomiting. CT scan of the abdomen and pelvis revealed postsurgical changes in proximal jejunum with no signs of obstruction. Small bowel enteroscopy showed a significant post anastomotic stricture from his previous surgery, with no evidence of retained ectopic pancreatic tissue both visually and on biopsies. The stricture was balloon dilated utilizing a through-the-scope balloon and the patient was discharged home. Ectopic Pancreas is very rare with an incidence of 0.2% during laparotomy and 0.5 to 13.7% on autopsies. It has been encountered in various locations such as the stomach, duodenum, jejunum, gallbladder, esophagus, common bile duct, spleen, mesentery, mediastinum, and fallopian tubes. Abdominal pain is the most common presentation due to inflammation from the release of pancreatic enzymes. There have been cases of gastric outlet obstruction from large gastric lesions. Endoscopy can reveal a submucosal mass, however it is difficult to diagnose ectopic pancreas visually, diagnosis is typically made via biopsy. We report a very rare case of jejunal ectopic pancreas that led to jejuno-jejunal intussusception. Thus, ectopic pancreas should be considered in patients presenting with intussusception.1294.tif Figure 1: Non-obstructing bowel intussusception in left upper quadrant, marked by yellow arrow