P2686 - Ectopic Pancreatic Tissue Leading to Intussusception of the Small Bowel

Kayla Martinez, ¹, Juleen Elizee, ¹, Adesuwa Inneh, ¹, Ana Shu, DO², Malik McKany, MD^2
1Ross University School of Medicine, Pontiac, MI; ²Trinity Health Oakland Hospital, Pontiac, MI

Introduction: Ectopic pancreas is a rare congenital anomaly, approximately 2% of postmortem examinations have identified pancreatic tissue that is aberrantly situated or ectopic. Sites of embryologic rests are composed of normal-appearing pancreatic tissue and are considered incidental findings. Although ectopic pancreas can be histologically normal tissue, if symptomatic, complications can be life-threatening.

Case Description/Methods: This is a 38 year-old male who presented with abdominal pain, nausea, and vomiting. His last bowel movement was at 03:00 on the day of his arrival. He reported having no significant past medical or surgical history, or ever having a colonoscopy. Computerized tomography of the abdomen revealed a 2.0 x 3.3 cm intraluminal lipoma with the distal small bowel, causing obstruction. An exploratory laparotomy was performed. Two areas of full-thickness ischemia were found within the small bowel wall, this was transected, a single anastomosis was done. The appendix appeared distended due to a mass, an appendectomy was done. Pathological examination relieved heterotopic pancreatic tissue surrounded by adipose tissue with overlying infarction to mucosa.

Discussion: Intussusception is most often seen in children, but adults can also suffer from this problem. Risk factors for intussusception include presence of Meckel diverticulum, cysts/polyps, and lymphoma. The pathophysiology of intussusception is caused by a lead point, forcing a segment of bowel to invaginate into itself. Treatment of intussusception in adults involves surgical intervention. Ectopic pancreas, also called heterotopic pancreas, is believed to be a congenital disorder, described as pancreatic tissue found outside the expected pancreatic frame. This abnormality is a result from separation of pancreatic tissue components during the process of rotation of the foregut followed by fusion of the pancreatic buds. Locations for ectopic pancreatic tissue include the stomach, duodenal wall, ileal wall, and the umbilicus. Treatment of ectopic pancreas includes surgical resection.

We present this case of intussusception due to ectopic pancreatic tissue in the small bowel in a middle-aged male presenting with small bowel obstruction. Careful consideration should be taken when performing surgical interventions for this condition, with the procedural goal of sparing the resection of viable segments of bowel. We aim to shed light on this disease presentation to assist in the care and management of future patients with similar symptoms.



Disclosures:


Kayla Martinez, ¹, Juleen Elizee, ¹, Adesuwa Inneh, ¹, Ana Shu, DO², Malik McKany, MD². P2686 - Ectopic Pancreatic Tissue Leading to Intussusception of the Small Bowel, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.