Heterotopic pancreatitis causing confusion in small bowel tumor.

A 39-year-old man was admitted to our hospital for acute epigastric pain with nausea and vomiting. Physical examination was suggestive for acute abdomen without peritoneal irritation findings. Blood tests results were as follow: alanine aminotransferase (ALT): 87 U/L, aspartate aminotransferase (AST): 55 U/L, amylase: 135 U/L, lipase: 69 U/L, total bilirubin: 11,6 mg/l, creatinine: 9 mg/l, C-reactive protein (CRP): 108,4 mg/L, and white blood cells (WBC): 14640/mm3. A contrast-enhanced computed tomography (CT) scan of the abdomen was performed, including a reformatted image in the axial plane (Fig. A) and a reformatted image in the coronal plane (Fig. B) and revealed an ovoid soft-tissue mass depending on jejunal wall with homogeneous enhancement (arrows). A short segment of a bowel loop was asymmetrically thickened, with surrounding mesenteric edema and mesenteric lymph nodes. Abdominal ultrasound (US) confirmed the above-mentioned description and showed an ovoid soft-tissue mass at the expense of the jejunal wall. The Doppler-US showed vascularization of the ovoid mass. The diagnosis of the jejunal tumor (probably gastrointestinal stromal jejunal tumor or lymphoma) was suggested. A laparoscopy was performed and revealed a mass which was removed and a short bowel segment was resected. Frozen sections (Fig. C) demonstrated ectopic pancreas infiltrating the mesentery and the jejunal wall to the sub mucosa with signs of pancreatitis.