Korean J Gastroenterol.  2013 Sep;62(3):165-168. 10.4166/kjg.2013.62.3.165.

A Case of a Jejunal Ectopic Pancreas Presenting as Obscure Gastrointestinal Bleeding

• Choi WH
• Chang HJ
• Seung JH
• Ko BS
• Kang SB

• KMID: 1707199
• DOI: http://doi.org/10.4166/kjg.2013.62.3.165

Abstract

A jejunal ectopic pancreas, where pancreatic tissue is found outside of the usual anatomical location, is a rare submucosal tumor that may cause obscure gastrointestinal (GI) bleeding. After initial negative endoscopic evaluation of the obscure GI bleeding, including colonoscopy and/or upper endoscopy, it is reasonable to proceed with further evaluation of the small bowel. Diagnostic options for the evaluation of the small bowel may include capsule endoscopy, push enteroscopy, or barium contrast small bowel studies. Here, we report a case of obscure GI bleeding caused by a jejunal ectopic pancreas, diagnosed through capsule endoscopy and barium contrast small bowel studies, which was treated successfully with single incision access laparoscopy.

Keyword

Pancreas; Gastrointestinal hemorrhage; Capsule endoscopy

MeSH Terms

Aged
Capsule Endoscopy
Diagnosis, Differential
Female
Gastrointestinal Hemorrhage/*diagnosis/surgery
Humans
Intestine, Small/radiography
Jejunum/pathology
Pancreas/pathology

Figure

• 

  Fig. 1. (A) Fresh blood gushed out from above the terminal ileum. (B) Capsule endoscopy revealed a submucosal lump with erosion located in the jejunum.

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  Fig. 2. The small bowel series demonstrated a 2-cm smooth, oval defect (arrow) without irregularity of the overlying mucosa in the distal jejunum.

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  Fig. 3. The gross specimen revealed a 1.5×2.0 cm submucosal mass. The erosion with the black sanguineous crust was considered to be the cause of the obscure gastrointestinal bleeding.

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  Fig. 4. A portion of the jejunum characterized as longer and with more irregular villi, no submucosal glands, and no aggregated lymphatic nodules. (A) An ectopic pancreas is located in the submucosa of the jejunum (H&E, ×40). This lesion demonstrates pancreatic acini (B, ×200) and secretory ducts (C,×200) in the submucosa of the jejunum (H&E).

Reference

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