Background

Ectopic pancreas is a rare congenital anomaly characterized by pancreatic tissue located outside its normal anatomic position and not connected to the main gland. Although frequently an incidental finding, it may lead to clinical symptoms such as abdominal pain, gastrointestinal bleeding, or, less commonly, acute or chronic pancreatitis. The diagnosis can be challenging, and endoscopic ultrasound (EUS) plays a decisive role in characterizing gastric subepithelial lesions and guiding their management.

Case Description

A 22-year-old woman with no significant medical history presented with five days of epigastric pain, heartburn and nausea. Laboratory tests revealed a five-fold elevation in serum lipase. Upper endoscopy identified two submucosal lesions, 2–3 cm in diameter, at the gastric antrum–body junction (Figure 1).

Radial and linear EUS demonstrated two heterogeneous, lobulated subepithelial masses along the greater curvature: one arising from the submucosa (20 × 12 mm) and another extending into the muscularis propria (22 × 14 mm), while preserving wall layer anatomy (Figure 2). Fine-needle aspiration (25G) confirmed ectopic pancreatic tissue without atypia.

Abdominal CT revealed solid, contrast-enhancing gastric-wall lesions with surrounding inflammatory changes, without involvement of the orthotopic pancreas (Figures 3 and 4). Given the patient’s clinical stability and the absence of complications, conservative management with outpatient follow-up was chosen, reserving endoscopic resection for possible recurrence.

Conclusion

This case illustrates acute idiopathic-like pancreatitis originating from gastric ectopic pancreatic tissue, confirmed by EUS-guided FNA. EUS was decisive in establishing the diagnosis and avoiding unnecessary investigations, delays, or inappropriate treatments in this uncommon entity. Careful follow-up is appropriate in clinically stable patients, while endoscopic resection remains a therapeutic option if symptoms recur.