Abstract
An 80-year-old man who had received appendectomy was seen at the hospital because of abdominal pain and nausea. An abdominal x-ray film taken when he was first seen revealed air-fluid level formation, but an abdominal CT scan failed to identify the origin of the intestinal obstruction. He was admitted with a diagnosis of adhesive intestinal obstruction that had come to the fifth admission in this year. Symptomatic remission was gained by conservative therapy, but laparoscopic-assisted surgery to reduce the obstruction was performed because he had repeatedly been affected by the condition. At surgery, dissection of adhesions between the abdominal wall and the ileum disclosed a narrowing intestine about 10 cm in length extending in the ileum with thickening of the mesentery, where was 30 cm proximal to the ileocecum and was thus determined to be the origin of the obstruction. Subsequently the ileum was pulled out from a small laparoscopic wound to outside of the body, and partial resection of the small intestine was performed. Histopathological examinations showed minor degree of inflammation of the ileum mucosa and structures like ducts in the pancreatic tissue in the small bowel mesentery, suggesting the presence of an ectopic pancreas. It was type III according to the Heinrich's classification. The final diagnosis was small vowel stenosis caused by ectopic pancreas in the small bowel mesentery. The patient has been free from intestinal obstruction as of 6 months after discharge.
