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Special Feature
September 01, 2005

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Departments of Surgery (Drs Fan and Zhang) and Pathology (Dr Gan), Taizhou Hospital, Wenzhou Medical College, Zhejiang, China; and Department of Surgery, Rogaland Regional Hospital, University of Bergen, Stavanger, Norway (Dr Andr[[eacute]]n-Sandberg).


Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Surg. 2005;140(9):911. doi:10.1001/archsurg.140.9.911

A 62-year-old man was admitted to the emergency department for abdominal trauma. His clinical record showed no previous abdominal symptoms such as pain, nausea, or vomiting. An emergency abdominal laparotomy was performed on the patient under general anesthesia. During completion of the surgery, a yellowish gray, rubbery 2.0 × 1.5 × 1.0-cm mass with a clear border was accidentally found on the antimesenteric side of the ileum, 30 cm from the ileocecal valve. A 5-cm segment of the ileum, containing the mass, was removed, and an end-to-end anastomosis was performed. The remainder of the bowel was grossly unremarkable, and the mass was submitted for light microscopic examination (Figure 1 and Figure 2).

Figure 1.
Image not available

The lesion, situated within the submucosa of the ileum, shows evidence of pancreatic ducts and acinar cells. Ileum mucosa is visible at the lower right (hematoxylin-eosin, ×100).

Figure 2.
Image not available

Histological specimen of the lesion, which is composed of pancreatic ducts, acinar cells, and islets of Langerhans (hematoxylin-eosin, ×100).

What Is the Diagnosis?

A. Leiomyoma

B. Adenomatous polyp

C. Meckel diverticulum

D. Pancreatic heterotopia