Gastric Pancreatic Heterotopia and Bronchoesophageal Fistula in a Patient With Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A Case Report

A 23-year-old woman with documented systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) and a recent pulmonary embolism requiring anticoagulation presented with acute hematemesis.Upper gastrointestinal endoscopy revealed a small mid-esophageal opening with mucus and air passage and an ulcerated gastric subepithelial lesion, without an identifiable active bleeding source.Chest computed tomography with oral contrast demonstrated a left bronchoesophageal fistula (BEF).Endoscopic ultrasonography showed a 20.8 × 15.4 mm hypoechoic lesion arising from the fourth sonographic layer of the gastric wall, corresponding to the muscularis propria, in the fundus/body region.The lesion was ulcerated and endophytic, raising suspicion for a gastrointestinal stromal tumor (GIST).EUS-guided tissue acquisition was deferred because of anticoagulation, and laparoscopic resection was performed.Histopathological examination revealed Heinrich type I gastric pancreatic heterotopia (GPH) involving the submucosa and muscularis propria, with pancreatic acini, ducts, and islet cells, accompanied by focal pancreatitis and chronic active gastritis.No malignancy was identified, and the surgical margins were free.Perioperative anticoagulation was managed by temporary interruption of warfarin with therapeutic enoxaparin bridging.The available records did not document definitive fistula-directed treatment or establish whether the BEF subsequently resolved or persisted.Although GPH and BEF coexisted in this patient, no direct anatomical or causal relationship could be established, and the source of hematemesis remained undetermined.This case highlights the diagnostic challenges of concurrent gastric and esophageal abnormalities in a patient with competing thrombotic and bleeding risks and underscores the importance of multimodal imaging, histopathological confirmation, and individualized perioperative anticoagulation management.