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      Bowel obstruction secondary to an ectopic pancreas in the small bowels: About 2 cases


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          • 2 cases of intestinal obstruction secondary to ectopic pancreas.

          • Ectopic pancreas causing intestinal occlusion is a very rare entity.

          • In the first case, the ectopic tissue caused mechanical luminal occlusion in the distal ileal part, whereas the 2nd case presented intussusception sign, 20 cm distal to the Treitz ligament.

          • Ectopic pancreas can serve as a lead point for ileo-ileal intussusception.



          Ectopic pancreas is most commonly found in the jejunum and stomach. Most patients remain asymptomatic, and the diagnosis is usually made at autopsy or incidentally. We report here 2 cases of intestinal occlusion, secondary to an ectopic pancreatic tissue. Both cases were managed successfully by laparoscopy and laparotomy with subsequent segmental intestinal resection.

          Case presentations

          Case 1 – An elderly patient presented to the ER because of intestinal occlusion. Paraclinical investigations were consistent with occlusion, with ileal suffering signs on CT-scan. After laparotomy and segmental intestinal resection were done, histopathalogy showed evidence of ectopic pancreas obstructing the intestinal lumen. Case 2 – A young man presented to the ER with acute onset of epigastric pain. signs of peritoneal irritation. Ct-scan showed evidence of small bowel intussusception. Exploratory laparoscopy was done, and confirmed the diagnosis. The intussusceptum was at the level of the proximal jejunum. The suffering intestinal part was exteriorized and then resected. Histopathology was consistent with an ectopic pancreas.


          Symptomatic ectopic pancreas is extremely rare. Symptoms may include, bleeding, intestinal occlusion and intussusception. Few similar cases have been reported in the literature, and the current ones are to be added.


          As mentioned above, ectopic pancreatic tissue rarely causes symptoms. We presented 2 cases that presented 2 possible complications secondary to this pathology. Both cases were managed successfully.

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          Most cited references11

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          The clinical significance of heterotopic pancreas in the gastrointestinal tract.

          A series of 34 histologically verified cases of pancreatic heterotopia in the records of the Department of Pathology at the University of Edinburgh between 1959 and 1979 has been analysed in order to determine the clinical significance of this unusual condition. In 13 patients (38 per cent) the heterotopic pancreatic tissue was symptomatic (i.e. the symptoms regressed completely on its removal). A correlation has been established between the presence of symptoms, the size of the lesion and the extent of mucosal involvement. Clinically significant lesions are greater than 1.5 cm in maximum diameter and are adjacent to or directly involve the mucosa.
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            Heterotopic pancreas. Review of a 26 year experience.

            A retrospective review of 37 patients (22 men and 15 women) with histologically verified heterotopic pancreas treated at the department of surgery of the University of California at Los Angeles Medical Center from 1959 to 1985 was carried out. There were 31 adults (mean age 50 years) and 6 children (mean age 2.8 years). The majority of lesions were in the stomach, duodenum, and jejunum. One was found inside a duplicated stomach. Symptomatic lesions were confined to the gastroduodenal region and were larger, with frequent mucosal ulceration. Upper gastrointestinal contrast roentgenograms were sensitive tools for detection (87.5 percent of patients) and diagnosis (71.4 percent of patients) of these lesions. Endoscopy should be performed whenever epigastric pain is the presenting symptom. Resection of the tissue-bearing segment of small intestine is advisable when encountered incidentally at operation. In the absence of endoscopic biopsy confirmation, we recommend surgical exploration and frozen section histopathologic study for all symptomatic patients. Limited local excision has been shown to be a safe and adequate procedure for patients with these congenital anomalies.
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              Heterotopic pancreas in the gastrointestinal tract.

              Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along with a 62-year-old man with abdominal pain caused by heterotopic pancreatic tissue in the gastric antrum. The difficulty of making an accurate diagnosis is highlighted. The patients remain healthy and symptom-free after follow-up of 1 year. Frozen sections may help in deciding the extent of resection intraoperatively. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of gastrointestinal stromal tumor.

                Author and article information

                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                11 January 2017
                11 January 2017
                : 31
                : 72-74
                [a ]Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon
                [b ]American University of Beirut, Faculty of Medicine, Beirut, Lebanon
                Author notes
                [* ]Corresponding author. Derdyail@ 123456hotmail.com
                © 2017 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Case Series

                ectopic pancreas,occlusion,intussusception
                ectopic pancreas, occlusion, intussusception


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