S3598 L.A Grade D Erosive Esophagitis With Incidental Ectopic Pancreas

Abstract

INTRODUCTION: Grade D erosive esophagitis and ectopic pancreas are both rare findings. We describe a patient that presented for an upper GI bleed with several risk factors for esophagitis. On endoscopy, L.A grade D erosive esophagitis was found along with an asymptomatic ectopic pancreas within the antrum of the stomach. CASE DESCRIPTION/METHODS: 58-year-old male with a history of tobacco usage, alcohol abuse, and GERD presented with alcoholic intoxication, black stools, and coffee-ground emesis for one day. He was found to have a hemoglobin of 7.7 from 13.5, hematocrit 21.3, elevated BUN and ALT. He was tachycardic and hypotensive. His skin showed pallor, abdomen was soft and tender to palpation in the epigastrium. Rectal exam was positive for black stool. He was given fluids and started on a PPI drip. The patient was admitted to the MICU for hemorrhagic shock. He received 2 unit’s FFP and 2 units PRBC prior to Endoscopy. EGD showed LA Grade D erosive esophagitis, a single lesion of aberrant pancreas in the stomach and gastritis. His hospital stay was uncomplicated and he was discharged with follow up. DISCUSSION: We describe a patient with L.A. grade D erosive esophagitis and ectopic pancreas. Both are rare conditions and present as a source of bleeding. Ectopic pancreas has an incidence of 0.2%, while grade C and D erosive esophagitis combined are 1% of all erosive esophagitis cases. The severity of erosive esophagitis in our patient is due to several factors, one being the patient’s 40 pack-year smoking history of which causes the LES pressures to be significantly lower. He had a hiatal hernia. The GE junction becomes both dilated and shorter, allowing for LES relaxation and increased acid reflux. His excessive alcohol drinking history can also reduce the LES tone and cause pyroptosis.On EGD our patient also had ectopic pancreas finding. This usually presents asymptomatically. This finding can pose a problem, as it can cause asymptomatic bleeding and can later develop into pancreatitis. Being a ETOH abuser, he is at risk for pancreatitis by both his ETOH usage and his ectopic pancreas.Periodic upper endoscopy must be done to monitor for cancer transformation, as ectopic pancreas can turn malignant at a rate of .7% to 1.8%. The extensive bleeding in our patient could have been due to the erosive esophagitis, aberrant pancreatitis or a combination of both. While both are rare findings, they can independently cause life-threatening complications and it is crucial to be aware that they can coexist together.Figure 1.: Aberrant pancreas in the Antrum of the Stomach.Figure 2.: Esophagitis.