A case of ectopic pancreas in the ileum presenting as obscure gastrointestinal bleeding and abdominal pain

Abstract

Background Ectopic pancreas is an infrequent submucosal tumor in the gastrointestinal tract defined as a pancreatic tissue lacking vascular or anatomic continuity with the main body of the pancreas. Ectopic pancreas in the ileum is a rare and often an incidental finding. We report a case of ectopic pancreas in the ileum causing obscure gastrointestinal bleeding and episodes of abdominal pain. Case presentation 59-year-old man with 3 months history of intermittent melena, accompanied by the episodes of abdominal pain in the left upper quadrant and generalized fatigue was admitted to our department. The investigations showed that the patient had a low hemoglobin level, i.e. 10.9 g/dL with hypochromic microcytic anemia pattern seen in complete blood count (MCV 70.2 fl, MCH 21.4 pg). Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Magnetic resonance enterography revealed a large (2.5 × 2.3 cm) pedunculated polyp in the ileum. Examination by single-balloon enteroscopy revealed a polyp with long pedicle located approximately 1.5 m distal to terminal ileum. Polypectomy was performed. Histopathologic examination stated, that the specimen contained ectopic pancreatic tissue which was involving muscular layer of the ileum. Ectopic pancreatic tissue included acinar cells and cystically dilated secretory ducts without islets of Langerhans. Conclusion Our case report reveals a very rare cause of obscure gastrointestinal bleeding accompanied by the episodes of abdominal pain – an ectopic pancreas located in the ileum.

Jejunal Ectopic Pancreas: A Rare Cause of Small Intestinal Mass

“…Type 1 (most common) contains acini, pancreatic ducts, and islet cells; type 2 is composed of acini and pancreatic ducts without islet cells; type 3 has only pancreatic ducts. Type 4 was later added by Gasper in 1973 which contains only pancreatic islet cells on histological examination [10]. Our case is an example of a type 1 EP.…”

“…It can show pancreatic ducts, acini, and/or islet cells on histology. EP was classified into three subtypes according to their histopathological findings by Heinrich in 1909 [10]. Type 1 (most common) contains acini, pancreatic ducts, and islet cells; type 2 is composed of acini and pancreatic ducts without islet cells; type 3 has only pancreatic ducts.…”

Unusual Cause of GI Bleed—Ectopic Pancreas

“…HP is a congenital anomaly arising from primitive gut and is a disease showing histological structures similar to normal pancreas without any anatomical relation or direct connection by blood vessel with the pancreas. Histologically, most of the lesions are situated in the submucosa, rarely in muscularis propria and only seldom in subserosa [1].…”

“…Ectopic pancreas is a rare anomaly of GI tract, also known as heterotopic pancreas or pancreatic rest [1]. It is defined as pancreatic tissue that has no contact with the orthotopic pancreas and has its own duct system and vascular supply [2].…”

A Rare Cause of Elevated Serum CA19-9

“…However, endoscopic resection via deep enteroscopy is an alternative method. 3 Keywords: CA 19-9; Double-Balloon Enteroscopy; Heterotopic Pancreas; Small Intestine.…”