Gastric Hematoma Secondary to Heterotopic Pancreas of the Stomach: Unexpected Cause of Upper Gastrointestinal Bleeding

Abstract

Upper gastrointestinal bleeding remains a common cause of hospitalizations and common causes include peptic ulcer disease, esophageal and gastric varices, and malignancies. Infrequently, rare and unexpected causes are encountered. Initial management is generally the same regardless of the cause that is focused on hemodynamic stabilization followed by endoscopy to assess and treat the cause of bleeding. We report a case of a 19-year-old female who presented with upper gastrointestinal bleeding and endoscopy showed a submucosal hematoma secondary to gastric ectopic pancreas or heterotopic pancreas. She was also treated for Helicobacter pylori infection. She was managed medically and was discharged without further recurrence of bleeding.

Keywords: ectopic pancreas; gastrointestinal bleeding; gastrointestinal hemorrhage; helicobacter pylori; intramural hematoma.

Figure 1. Upper gastrointestinal endoscopy of the patient.

Endoscopy shows the antrum with a submucosal mass (indicated by X) on the greater curve with a bluish tinge pointing towards the pylorus (cannot be seen indicated by black arrow). The mucosal of the antrum greater curve has a granular texture (A). Forceps (F) and gastric incisura (GI).

Figure 2. Axial computed tomography (CT) scan of the abdomen.

The image shows a cystic mass in the antrum (white arrow) corresponding to the lesion seen on endoscopy. Liver (L), gallbladder (Gb indicated by open black arrow); body of stomach (S), spleen (Sp), pancreas (P), and left kidney (K).

Figure 3. Repeat endoscopy was done after four weeks.

The image shows a tubular structure in the antrum of heterotopic pancreas (HP) corresponding to the location of the submucosal mass seen in the first endoscopy. Opening of the HP located within the depression is indicated by the black arrow.