Jejunal Ectopic Pancreas: A Case Report and Literature Review.

This case report describes a rare etiology of a symptomatic small bowel mass that had been causing our patient spontaneous abdominal pain, nausea, and loss of appetite. The patient is a 53-year-old Caucasian male undergoing chemotherapy and radiation for a nasopharyngeal Epstein-Barr virus-positive carcinoma. He presented to the urgent care with two days of sharp upper abdominal pain and nausea without association of symptoms to prior chemotherapy treatments. Workup initially suggested a jejunal hematoma, which was later revealed to be a mass. The patient underwent outpatient robot-assisted laparoscopic resection of the mass. Pathology demonstrated benign ectopic pancreatic tissue invading through the serosa into the muscularis propria with the sampled lymph nodes negative for malignancy. Ectopic pancreas is a rare congenital abnormality most commonly found in the gastrointestinal tract. Most cases are asymptomatic, but epigastric pain is the most common symptom, followed by nausea, vomiting, and hematochezia. While a benign finding, the index of suspicion for malignancy should remain high as diagnosis can be difficult. Ectopic pancreatic tissue is susceptible to the same pathology that may affect a native pancreas, including pancreatitis and pancreatic malignancy. Radiological and endoscopy studies are useful adjuncts that may increase clinical suspicion; however, it is difficult to differentiate ectopic pancreas from a neoplasm without tissue biopsy. Although no standardized approach exists, surgical resection remains a mainstay of diagnosis and treatment, especially in anatomic locations not amenable to endoscopic intervention.