A Rare Case of Gastric Aberrant Pancreas Causing Bleeding from a Gastric Ulcer

An aberrant pancreas is pancreatic tissue lacking anatomical and vascular continuity with the normal pancreas. It typically occurs in the gastrointestinal tract, especially in the stomach, duodenum, and small intestine. Most cases are asymptomatic and discovered incidentally during imaging or surgery. Gastric aberrant pancreas rarely presents with bleeding, making diagnosis and treatment decisions challenging.

A 34-year-old man presented with epigastric pain and melena. Endoscopy at a local hospital revealed a submucosal tumor (SMT) with active bleeding at the greater curvature of the stomach. After admission, further imaging and endoscopic ultrasonography showed a 20-mm low-echo mass in the submucosa and muscularis propria with ulceration. Histopathology of a biopsy confirmed aberrant pancreatic tissue. Due to progressive anemia from ulcer bleeding, laparoscopic partial gastrectomy was performed. The SMT was completely resected, and the postoperative course was uneventful. Pathological examination confirmed a Heinrich type I aberrant pancreas.

Most cases of aberrant pancreas are asymptomatic; however, in this case, a preoperative diagnosis of gastric submucosal aberrant pancreas was made by endoscopic examination and puncture aspiration cytology because of the relatively rare bleeding symptoms. In this case, laparoscopic partial gastrectomy was performed to control bleeding.