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Keerthana Bachala
#609, Hostel 10, AIIMS, Patna - 801 507, Bihar
India

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Sir,

Inflammatory myofibroblastic tumor (IMT) is a benign and unusual solid tumor that mostly affects children.[1] The most common site is lungs and the incidence is less than 1 in 1 million.[2] We, hereby, report a case of jejunal IMT presenting as subacute intestinal obstruction associated with pancreatitis.

A 1-year-old female child presented with bilious vomiting and constipation and abdominal distension for the past 3 months. On examination, the child had epigastric distension with mild tenderness. The child was managed conservatively. Contrast-enhanced computed tomography abdomen, however, revealed an enhancing circumferential mass around 2 cm at proximal jejunum and bulky pancreas. Serum amylase was 130 IU/L and serum lipase was 366 IU/L. On exploratory laparotomy, a 2 x 2 cm, firm, smooth mass was noted arising from the jejunum. The mass was 10 cm distal to duodeno-jejunal flexure and was encasing about 80% of the bowel lumen [Figure 1]a. Resection of the mass with end-to-end anastomosis was done. Postoperative period was uneventful. Ascitic amylase level was 266 IU/L and ascitic lipase was 4046 IU/L.{Figure 1}

Histopathological examination (HPE) revealed spindle cell neoplasm arising from serosal layer of the intestine [Figure 1]b. Immunohistochemistry confirmed IMT [Figure 1]b. The child was followed up for a period of 6 months and was asymptomatic.

In our case, pancreatitis could be associated with local inflammatory changes caused by the tumor and its proximity to pancreas. To our knowledge, this is the first reported case of jejunal IMT associated with pancreatitis.

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