Bifid tail of the pancreas: a case presenting as a gastric submucosal tumor

A 49-yr-old male was admitted to our hospital because of epigastric discomfort and a suspected tumor of the stomach on barium meal examination at the Center for Automated Multiphasic Health Test and Services. The tumor shadow of the stomach was initially considered as the "type II" gastric carcinoma according to the Borrmann's classification. Multiple endoscopical and electrocautery cutting biopsies revealed that the tumor occurred in the submucosal layer and was composed of normal pancreatic tissue. A computed tomogram showed a large mass on the pancreatic body which was adjacent to gastric wall. Selective angiography of the celiac trunk revealed that the gastric submucosal lesion was supplied by the transverse pancreatic artery. Endoscopic retrograde pancreatography showed that Wirsung's duct had a divergence in the body of the pancreas and one of the branched ducts headed for the posterior wall of the gastric body. On the basis of these results, a diagnosis was made of the rare pancreatic anomaly, "bifid tail of the pancreas." One of the tails formed the gastric submucosal tumor. This report emphasizes the potential diagnostic value of combined study of endoscopic retrograde pancreatography and computed tomography in determining the presence of pancreatic anomaly.