Intussusception is rare in adults. We describe a 62-yearold man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdominal pain. Plain abdominal radiography showed some intestinal gas and fluid levels. Abdominal CT scan demonstrated a target sign suggesting bowel intussusception. Jejunography using a naso-jejunal tube showed an oval-shaped mass about 15 mm in diameter with a smooth surface in the jejunum, which suggested a submucosal tumor (SMT), and edematous mucosa around the mass. Partial jejunal resection was carried out and the resected oval-shaped tumor, 14 mm × 11 mm in size, was found to be covered with normal jejunal mucosa. The tumor was histologically diagnosed as type Ⅲ ectopic pancreas according to the classification proposed by Heinrich. Abdominal pain resolved postoperatively. This case reminds us that jejunal ectopic pancreas should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.

A case of pedunculated Brunner's gland hamartoma (BGH) of the duodenum causing upper gastrointestinal (GI) hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath. Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding, about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several lobules of mature Brunner's gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.

Abstract

A case of gastric hyperplastic polyp with proliferation of xanthoma cells is reported. The patient was a 69-year-old man who visited our hospital for further evaluation of gastric polyps. Endoscopic examination of the upper digestive tract revealed multiple hyperplastic polyps in the gastric antrum. There was a pedunculated polyp with whitish yellow granules, 7 mm in diameter, arising from the greater curvature of the antrum. Magnification narrow-band imaging endoscopy (GIF-H260Z, Olympus) revealed long microcapillaries in the polyp but did not reveal disappearance of the mucosal microstructure or irregular branched capillaries. Endoscopic mucosal resection (EMR) was performed. Histological examination of the specimen revealed the lengthened gastric foveolae in the superficial portion and tight sheet of foamy histiocytes in the lamina propria. Diagnosis of gastric hyperplastic polyp with proliferation of xanthoma cells was made. There was no evidence of malignancy. It is necessary to know that a gastric hyperplastic polyp may associate with gastric xanthoma, although such association is very rare.