t s b A otherwise healthy woman presented with recurrent abdominal pain of 8-years’ duration. She recalls he pain staring after a hysterectomy. The pain was described as ttacks of recurrent, sharp, colicky, periumbilical pain that adiated to the left flank and groin. She had visited her primary are physician, several gastroenterologists, and the emergency oom on several occasions for these pains. The patient had been iagnosed with “irritable bowel syndrome.” The clinical examnation was unremarkable except for epigastric tenderness on eep palpation. The laboratory data were within reference anges, except for a repeatedly mildly elevated lipase (83 U/L; ormal 13– 60 U/L). A computed tomography scan performed t an outside facility was reported as completely normal. Varius endoscopies including an esophagogastroduodenoscopy, leocolonoscopy, and double-balloon enteroscopy were unrearkable. We reviewed the outside computed tomography scan f the abdomen, which demonstrated a suspected calcified esion in the left upper quadrant (Figure A). During exploratory laparotomy, a subserosal ectopic pancreas of the upper jejunum was discovered (Figure B). Adjacent to the ectopic pancreas, there was a white cauliflower-like structure representing saponification and calcification of fat which had likely been induced by the exudate of pancreatic enzymes during each “attack of pancreatitis” (Figure C). The involved segment of small bowel was removed. The resected specimen contained normal pancreas parenchyma with lobulated acinar tissue and islets of Langerhans, ductular structure, and areas of adipose tissue. The patient has not had any similar episodes of pain during an 8-month follow-up period. Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position, with no ductal or vascular communication with the native pancreas.1,2 Ectopic pancreas can occur anywhere in the gastrointestinal tract and is usually an incidental finding at endoscopy, surgery, or autopsy.1,2 Alhough these lesions are generally silent, they may become ymptomatic as a result of complications such as obstruction, leeding, pancreatitis, and malignant transformation.2 This case is interesting for several reasons. First, we show that ectopic pancreatitis should be kept in the differential diagnosis of chronic, recurrent, abdominal pain. Second, this case shows that submucosal lesions may be missed during deep enteroscopy. Third, we show that careful review (ie, “second look”) of x-ray studies should be attempted in any patient with unclear abdominal pain. If a second x-ray examination is not possible, obtaining new imaging tests should be strongly pursued. In summary, in a patient with recurrent, unclear abdominal pain, even in the absence of elevated serum amylase/lipase, ectopic pancreatitis should be included in the differential diagnosis.