This is a case report of the coexistence of two rare conditions, LiPH of the pancreas and a huge pedunculated BGH of the duodenum, in which the patient presented with upper GI bleeding secondary to ulceration of BGH.īrunner’s glands are tubuloalveolar exocrine glands predominantly located in the submucosa of the proximal duodenum. Esophagogastroduodenoscopy revealed a large submucosal mass along the C-shaped loop of the duodenum, the size of the tumor was about 100 mm in the longest diameter with central ulceration, which was considered the origin of bleeding (Figure 3). Furthermore, focal cystic dilatations of intrahepatic bile ducts in the left hepatic lobe (localized biliary ectasia) were also detected on CT and MRI (Figure 2C, D). Both CT and MRI findings suggested the diagnosis of LiPH. Fatty tissue infiltrated not only the pancreatic parenchyma but also the duodenal wall (Figure 2A, B). Magnetic resonance imaging (MRI) with T1-weighted, T2-weighted, and fat-suppression images showed a large mass-like lesion containing adipose tissue from the pancreatic head to tail (Figure 1). The main pancreatic duct was not narrowed or dilated, and no tumor was detected (Figure 1). Dynamic abdominal computed tomography (CT) showed marked thickening of the duodenal walls and fatty replacement over the entire pancreatic parenchyma with no delineation between the pancreas and duodenum.