Ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy

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.

Keywords: Capsule endoscopy; Ectopic pancreas; Gastrointestinal hemorrhage.

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).