Partial Intestinal Obstruction by Pancreatic Adenomyoma of Jejunum

Nam, Young Soo; Park, Hwon Kyum; Baik, Hong Kyu; Lee, Hong Gi; Jang, Se Jin; Park, Yong Wook

Abstract

Pancreatic heterotopia and adenomyoma are variants of the same process. Pancreatic heterotopia is characterized by the presence of pancreatic acinar, islet, and/or ductular elements, usually associated with smooth muscle proliferation, outside the topographic boundaries of the pancreas. Adenomyoma differs from pancreatic heterotopia in that acinar and islet-like tissue are not present. The common sites are stomach, duodenum, and jejunum, but ectopic pancreatic tissue may also be encountered in Meckel's diverticulum, the ampulla of Vater, gallbladder, umbilicus, fallopian tube, and mediastinum. Most examples are encountered incidentally during surgery, and on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been attributable directly to the presence of the heterotopic pancreas. But intestinal obstruction of small bowel by pancreatic adenomyoma has not been reported as of yet. The authors have experienced one case of intestinal obstruction by pancreatic adenomyoma requiring operation in a 28-year-old female. We found the 3-fold distened proximal jejunal loop, about 1 meter length, and abrupted narrowed point, and a normal sized distal loop. We treated this case by performing longitudinal incision and transverse suture of the narrowed point, so that the diameter of narrowed point was enlarged. At that time we found the 0.7Cm sized intraluminal mass at the narrowed point. We concluded that intestinal obstruction in this case was made by contraction of circular muscle due to pancreatic adenomyoma, not by a mass effect.