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

Woo Hyung Choi; Hyoung Jin Chang; Jee Hwan Seung; Bong Suk Ko; Sang Bum Kang

doi:10.4166/kjg.2013.62.3.165

Journal List > Korean J Gastroenterol > v.62(3) > 1007135

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Choi, Chang, Seung, Ko, and Kang: A Case of a Jejunal Ectopic Pancreas Presenting as Obscure Gastrointestinal Bleeding

Case Report

Korean J Gastroenterol 2013;62(3):165-168.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.3.165

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

Woo Hyung Choi, Hyoung Jin Chang, Jee Hwan Seung, Bong Suk Ko, Sang Bum Kang

Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea

Correspondence to: Sang Bum Kang, Division of Gastroenterology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 301-723, Korea. Tel: +82-42-220-9823, Fax: +82-42-221-9038, E-mail: ksb1999@hanmail.net

Received 13 January 2013 Accepted 25 March 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pancreas, Gastrointestinal hemorrhage, Capsule endoscopy

References

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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.

Fig. 2.

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

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.

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).

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