Obscure gastrointestinal bleeding secondary to ectopic pancreas. Case report
DOI:
https://doi.org/10.5281/zenodo.10713031Keywords:
Ectopic Pancreas, Gastroenterology, Jejunum, Gastrointestinal Hemorrhage, Pancreatic DiseasesAbstract
Background: Ectopic pancreas is a benign subepithelial tumor with an abnormal anatomical position, typically diagnosed incidentally as it does not produce symptoms and is challenging to identify in paraclinical studies. The incidence is very low, so our objective is to present the case of a patient with ectopic pancreas as a rare cause of obscure gastrointestinal bleeding.
Clinical case: A 70-year-old man presented with melena, anemia, and weight loss. The initial approach involved endoscopic studies (panendoscopy, colonoscopy, enteroscopy), a tagged red blood cell scan and computed tomography, none of which identified the bleeding site. Therefore, an exploratory laparoscopy was performed, revealing a 3 x 3 cm exophytic lesion in the proximal jejunum, which was completely resected. Histopathology confirmed an ectopic pancreas.
Conclusions: This condition is an uncommon but potentially serious cause of gastrointestinal bleeding, as the definitive diagnosis is often delayed. Therefore, clinical suspicion is crucial for early diagnosis and timely treatment, involving a multidisciplinary team of specialists in gastroenterology, radiology, pathology, and general surgery. In this manuscript, we present one of the few reported cases of ectopic pancreas as the cause of mid-intestinal bleeding.
Downloads
References
Lee CW, Lin YC, Hsu HT, et al. Endoscopic Ultrasound Appearance of Jejunal Ectopic Pancreas Mimicking Metastatic Nodule in a Cancer Patient. Diagnostics. 2023;13(4):660. doi: 10.3390/diagnostics13040660.
Sharma M, Annapurna V, Sulakshana MS, et al. Pancreatic Choristoma in Omentum in Advanced CA Ovary: A Clinical Puzzle. Indian J Gynecol Oncol. 2023;21(2):32. doi: 10.1007/s40944-023-00706-8.
Kumar V, Gala D, Gustke C, et al. Pancreatic Heterotopia at the Gastroesophageal Junction: A Case Report and Review of the Literature. Cureus. 2023;15(3):e35830. doi: 10.7759/cureus.35830.
Pham NTT, Nguyen ANT, Vo MTT, et al. Heterotopic Pancreas in the Duodenum Diagnosed after Laparoscopic Biopsy. Case Rep Gastroenterol. 2022;16(3):546-551. doi: 10.1159/000526135.
Dhruv S, Polavarapu A, Asuzu I, et al. Jejunal Ectopic Pancreas: A Rare Cause of Small Intestinal Mass. Cureus. 2021;13(6): e15409. doi: 10.7759/cureus.15409.
Daniel NE, Rampersad FS, Naraynsingh V, et al. Jejunal Intussusception Due to Heterotopic Pancreas: A Case Report. Cureus. 2021;13(4):e14586. doi: 10.7759/cureus.14586.
Kim JE. Ectopic pancreas with lipoma in the distal jejunum: A case report. Eur J Radiol Open. 2020;8:100318. doi: 10.1016/j.ejro.2020.100318.
Saeed MF, Verhagen KR, Albinali S, et al. A case report and literature review: incidental jejunal ectopic pancreatic tissue in an emergency bowel exploration for suspected intussusception. AME Case Rep. 2019;3:24. doi: 10.21037/acr.2019.07.05.
Awadie H, Zoabi A, Gralnek IM. Obscure-overt gastrointestinal bleeding: a review. Pol Arch Intern Med. 2022;132(5):16253. doi: 10.20452/pamw.16253.
Ammar H, Said MA, Mizouni A, et al. Ectopic pancreas: A rare cause of occult gastrointestinal bleeding. Ann Med Surg (Lond). 2020;59:41-43. doi: 10.1016/j.amsu.2020.09.005.
Yang YB, Liu YQ, Dai L, et al. Malignant transformation of heterotopic pancreas as middle esophagus adenocarcinoma-A rare case report and comprehensive literature review. Thorac Cancer. 2022;13(7):1083-1087. doi: 10.1111/1759-7714.14344.
Bejiga G. Gastric outlet obstruction secondary to heterotopic pancreas being mistaken for gastric cancer: "Case report". Int J Surg Case Rep. 2022;93:106974. doi: 10.1016/j.ijscr.2022.106974. Epub 2022 Mar 29.
Mirzaie S, Hu TX, Yang L, et al. Gastric outlet obstruction caused by heterotopic pancreas in a patient with alcohol use disorder. Int J Surg Case Rep. 2023;105:107974. doi: 10.1016/j.ijscr.2023.107974.
Zhang P, Wang M, Bai L, et al. A unique case of ectopic pancreas presenting as jejunal malignance. J Surg Case Rep. 2019;2019(7):rjz217. doi: 10.1093/jscr/rjz217.
Aslan S, Nural MS. CT features of asymptomatic heterotopic pancreas in jejunal mesentery. Turk J Gastroenterol. 2019;30(2):208-210. doi: 10.5152/tjg.2018.18064.
Xu YE, Hendahewa R. A rare case of mesenteric heterotopic pancreas presenting as an inflammatory mass. J Surg Case Rep. 2020;2020(2):rjz395. doi: 10.1093/jscr/rjz395.
Subasinghe D, Sivaganesh S, Perera N, et al. Gastric fundal heterotopic pancreas mimicking a gastrointestinal stromal tumour (GIST): a case report and a brief review. BMC Res Notes. 2016;9:185. doi: 10.1186/s13104-016-1995-5.
Patel A, Hellmann A, Spychalski P, et al. Jejunal ectopic pancreas mimicking a gastrointestinal stromal tumor. Pol Arch Intern Med. 2020;130(1):77-78. doi: 10.20452/pamw.14992.
Shamoon D, Sostre V, Patel V, et al. A Case of Heterotopic Pancreatic Tissue Discovered in the Distal Esophagus. Case Rep Gastrointest Med. 2020;2020:4695184. doi: 10.1155/2020/4695184.
Xiang S, Zhang F, Xu G. Ectopic pancreas in the ileum: An unusual condition and our experience. Medicine (Baltimore). 2019;98(44):e17691. doi: 10.1097/MD.0000000000017691.
Yamauchi R, Yamada T, Yamaguchi T, et al. A Rare Case of the Jejunal Ectopic Pancreas Observed with an Endoscope. ACG Case Rep J. 2021;8(5):e00614. doi: 10.14309/crj.0000000000000614.
Mohanaraj T, Hanif H, Zainal AA. Bleeding Jejunal GIST: An uncommon cause of Gastrointestinal Bleeding. Med J Malaysia. 2015;70(1):31-2. PMID: 26032526.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Revista Médica del Instituto Mexicano del Seguro Social
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.
