Ectopic pancreas and intestinal volvulus

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A 39-year-old man, with no previous pathology, started with epigastric pain two months ago. He described that the pain irradiated into the back and was associated with postprandial vomiting. Due to the increased severity of the pain, the patient went to our Emergency Department and preformed complementary examinations: Abdominal and pelvic computed tomography (CT) described a volvulus in the duodenal–jejunal transition with evidence of intestinal malrotation with the corkscrew sign (Figure 1A); inversion of the superior mesenteric vein and artery (Figure 1B); complete abdominal rotation with the colon on the right and the Treitz also on the right (Figure 1C). These findings were associated with duodenal and gastric dilation upstream. There was also the presence of a nodular lesion at the pyloric region with nearly 22 mm (Figure 2). Upper endoscopy: presence of a polypoid mass with a central umbilicus localized in the great curvature of the prepyloric region. This patient was proposed to surgical treatment and during the surgery there were the following findings: Malrotation of the small bowel with the Treitz on the right; torsion of the first jejunal loop due to the presence of fibroelastic and subserosal tumefaction with approximately 3 cm localized within the mesenteric side of the jejunum. The surgeons proceeded to the untwist of the small bowel and a segmentar enterectomy in the place where the lesion was localized. Histology described a submucosal nodule compatible with an ectopic pancreas without sign of malignant cells.