Atypical Presentation of Jejunojejunal Intussusception Due to Ectopic Pancreas in a Young Male

Abstract

Background: Intussusception may be caused by a variety of conditions and more commonly involves the ileum. Jejunojejunal intussusception is a rare condition and may originate from intramural tumors. Ectopic pancreatic tissue may be found throughout the entire gastrointestinal track causing no symptoms. Case Report: A 29 year old African American male presented with cramping abdominal pain and nausea to the emergency room. As a child he had multiple trips to the ER for abdominal pain but no diagnosis had been made. Five years earlier a small bowel intussusception was found on CT-scan but exploratory laparotomy was negative. The patient had remained asymptomatic until 3 months prior to the new episode. CT-scan showed recurrent intussusception of the proximal small bowel. An extensive work-up did not reveal diagnosis but the patient was readmitted multiple times for abdominal pain and again signs of intussusceptions were found. He underwent exploratory laparoscopy and no intussusception but a small yellowish lesion at 10cm past the ligament of Treitz was detected. A segmental jejunal resection containing the 1.5cm lesion was performed. Pathology revealed a transmural lesion consistent with ectopic pancreatic tissue. The immediate postoperative course was uneventful and the patent improved; however, he continued to have episodes of abdominal cramping but further workup was negative and we believe he suffered from a motility disorder due to the chronic dilatation of the duodenum and proximal jejunum associated with the recurrent intussusceptions. Discussion: We present a rare case of ectopic pancreas causing recurrent jejunojejunal intussusceptions in an adult; these small lesions may be difficult to find and should be surgically removed as the recurrent obstructions may cause long term damage to the proximal intestinal segments. Laparoscopy should be the preferred approach for such cases.