Jejunal small ectopic pancreas developing into jejunojejunal intussusception: a rare cause of ileus

Abstract

Intussusception is rare in adults. We describe a 62-year-old man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdominal pain. Plain abdominal radiography showed some intestinal gas and fluid levels. Abdominal CT scan demonstrated a target sign suggesting bowel intussusception. Jejunography using a naso-jejunal tube showed an oval-shaped mass about 15 mm in diameter with a smooth surface in the jejunum, which suggested a submucosal tumor (SMT), and edematous mucosa around the mass. Partial jejunal resection was carried out and the resected oval-shaped tumor, 14 mm x 11 mm in size, was found to be covered with normal jejunal mucosa. The tumor was histologically diagnosed as type III ectopic pancreas according to the classification proposed by Heinrich. Abdominal pain resolved postoperatively. This case reminds us that jejunal ectopic pancreas should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.

Figure 1

Jejunography using a naso-jejunal tube showed an oval-shaped mass in the jejunum (arrow) and edematous mucosa around the mass.

Figure 2

Macroscopic findings of the tumor. A 14 mm × 11 mm oval-shaped submucosal tumor covered with normal mucosa was observed.

Figure 3

Histological findings of the tumor. The localized tumor was composed of proliferating ducts and proliferation of smooth muscle bundles without mitotic figures. However, both exocrine acini and endocrine elements were lacking (HE, × 100).