2020 Volume 53 Issue 6 Pages 512-517
A 76-year-old woman was admitted to our hospital with epigastric pain. Laboratory tests revealed white blood cell count, serum amylase, and lipase were elevated. Abdominal CT showed mesenteric edema below the left kidney without continuity to the normal pancreas. Ectopic pancreatitis was suspected and she was hospitalized. Two days after admission, the abdominal pain moved to the right abdomen and exacerbated inflammatory response in blood examination. On abdominal CT, the mesenteric edema moved to the right upper part of the abdomen and a high-density area associated with bleeding was observed inside. Ascites also appeared. Therefore, she was referred to our department, and emergency surgery was performed on the same day. A change in color of the jejunal mesentery and hematoma formation could be observed at 20 cm to 50 cm on the anal side of the ligament of Treitz. We suspected mesenteric penetration due to jejunal diverticulitis, and performed resection of the mesenteric hematoma and the segment of jejunum. Pathologically, the ectopic pancreas developed near the jejunal diverticulum, and had a ductal orifice to the diverticulum, causing acute hemorrhagic pancreatitis.
