Giant heterotopic pancreas presenting with massive upper gastrointestinal bleeding

Heterotopic pancreas, or pancreatic rest, refers to extra-pancreatic tissue without an obvious vascular or anatomic connection with the pancreas. Although the frequency of heterotopic pancreatic tissue in autopsy series has been reported as high as 14%, clinical manifestations are rare [2]. Although common in the upper gastrointestinal tract, heterotopic pancreatic tissue rarely causes gastrointestinal bleeding. In a large case series following patients with heterotopic pancreatic tissue, only 7 of 212 patients had any evidence of bleeding [3]. We present a patient who presented with massive hematochezia found to have a giant heterotopic pancreas in the duodenum.