Clin Endosc.  2012 Sep;45(3):194-197.

Ectopic Pancreas Bleeding in the Jejunum Revealed by Capsule Endoscopy

• Lee MJ
• Chang JH
• Maeng IH
• Park JY
• Im YS
• Kim TH
• Han SW
• Lee DS

Abstract

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.

Keyword

Capsule endoscopy; Gastrointestinal hemorrhage; Ectopic pancreas

MeSH Terms

Autopsy
Capsule Endoscopy
Duodenum
Gastrointestinal Hemorrhage
Hemorrhage
Incidence
Inflammation
Jejunum
Pancreas
Stomach

Figure

• 

  Fig. 1 Capsule endoscopic findings. Capsule endoscopy reveals a submucosal lesion, with active bleeding from central umbilicated surface located in the jejunum.

• 

  Fig. 2 Gross findings of the resected specimen. (A) A 1.5×1.5 cm submucosal tumor with yellow and rubbery mucosal surface. (B) Erosion or umbilication is seen on the surface of tumor.

• 

  Fig. 3 Microscopic findings of the resected specimen. (A, B) Histologic examination of the resected specimen revealed exocrine tissue of the pancreas with acinus structures and secretory ducts seen in the submucosa (A, H&E stain, ×40; B, H&E stain, ×100). (C) Focal mucosal defect (2 mm) is seen on the surface of tumor (H&E stain, ×40).

Reference

1. Lai EC, Tompkins RK. Heterotopic pancreas. Review of a 26 year experience. Am J Surg. 1986; 151:697–700. PMID: 3717502.

2. Armstrong CP, King PM, Dixon JM, Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. Br J Surg. 1981; 68:384–387. PMID: 7237066.

3. Chen HL, Chang WH, Shih SC, Bair MJ, Lin SC. Changing pattern of ectopic pancreas: 22 years of experience in a medical center. J Formos Med Assoc. 2008; 107:932–936. PMID: 19129053.

4. Dolan RV, ReMine WH, Dockerty MB. The fate of heterotopic pancreatic tissue. A study of 212 cases. Arch Surg. 1974; 109:762–765. PMID: 4420439.

5. Chen HL, Lin SC, Chang WH, Yang TL, Chen YJ. Identification of ectopic pancreas in the ileum by capsule endoscopy. J Formos Med Assoc. 2007; 106:240–243. PMID: 17389169.

6. Hsia CY, Wu CW, Lui WY. Heterotopic pancreas: a difficult diagnosis. J Clin Gastroenterol. 1999; 28:144–147. PMID: 10078823.

7. Ba MC, Qing SH, Huang XC, Wen Y, Li GX, Yu J. Diagnosis and treatment of small intestinal bleeding: retrospective analysis of 76 cases. World J Gastroenterol. 2006; 12:7371–7374. PMID: 17143959.

8. Mekky MA, Yamao K, Sawaki A, et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc. 2010; 71:913–919. PMID: 20226456.

9. De Castro Barbosa JJ, Dockerty MB, Waugh JM. Pancreatic heterotopia; review of the literature and report of 41 authenticated surgical cases, of which 25 were clinically significant. Surg Gynecol Obstet. 1946; 82:527–542. PMID: 21024692.

10. Hsu SD, Chan DC, Hsieh HF, Chen TW, Yu JC, Chou SJ. Ectopic pancreas presenting as ampulla of vater tumor. Am J Surg. 2008; 195:498–500. PMID: 18304504.

11. Fan BG, Zhang FB, Gan MF, Andrén-Sandberg A. Image of the month: heterotopic (ectopic) pancreas of ileum. Arch Surg. 2005; 140:911–913. PMID: 16172299.

12. Minamoto T, Ueda H, Ooi A, Omote K, Ogino T, Mai M. A limitation of endoscopic ultrasound: an unusual case of early gastric cancer overlying a pancreatic rest. Am J Gastroenterol. 1991; 86:622–626. PMID: 2028957.

13. Leighton JA, Goldstein J, Hirota W, et al. Obscure gastrointestinal bleeding. Gastrointest Endosc. 2003; 58:650–655. PMID: 14595294.

14. Forner A, Mata A, Puig M, et al. Ileal carcinoid tumor as a cause of massive lower-GI bleeding: the role of capsule endoscopy. Gastrointest Endosc. 2004; 60:483–485. PMID: 15332054.

15. Chung IS, Cha SB, Park DH, et al. Esophagus, stomach & intestine: a case of ectopic pancreas of the duodenum with massive upper gastrointestinal bleeding. Korean J Gastrointest Endosc. 1997; 17:195–199.

16. Joo YE, Kim HS, Choi SK, et al. Massive gastrointestinal bleeding caused by ectopic pancreas mimicking jejunal tumor. Digestion. 2001; 64:133–136. PMID: 11684829.

17. Takeda Y, Nakase H, Chiba T. Ectopic pancreas at the jejunum. Dig Liver Dis. 2011; 43:e6. PMID: 20570222.

18. Hartmann D, Schmidt H, Bolz G, et al. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc. 2005; 61:826–832. PMID: 15933683.

19. Maieron A, Hubner D, Blaha B, et al. Multicenter retrospective evaluation of capsule endoscopy in clinical routine. Endoscopy. 2004; 36:864–868. PMID: 15452781.

20. Neu B, Ell C, May A, et al. Capsule endoscopy versus standard tests in influencing management of obscure digestive bleeding: results from a German multicenter trial. Am J Gastroenterol. 2005; 100:1736–1742. PMID: 16086709.