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Heterotopic gastric mucosa (HGM) is gastric mucosal tissue outside the stomach. It can be discovered anywhere throughout the gastrointestinal tract and is mostly asymptomatic. HGM, although rare beyond the ligament of Treitz, should be included in the differential diagnosis in a young patient with a polyp causing obstructive symptoms or bleeding. V...
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INTRODUCTION: Multiple diverticulosis of the jejunum constitutes an uncommon pathology of the smallbowel. The disease is often asymptomatic and must be taken into consideration in cases of unexplainedmalabsorption, anemia, chronic abdominal pain and discomfort.CASE PRESENTAION: We are thereby reporting a 50 yr patient on chronic NSAID ingestion pre...
Citations
... The incidence of HG in esophagus varies from 0.1% to 13.8% and that of the duodenum is 0.5%-8.9%. [16,17] Uncommonly found in salivary gland, gall bladder, biliary duct, umbilicus, respiratory tract, bronchogenic and thyroglossal cyst, spinal column (intra-abdominal and intrathoracic locations), urinary bladder, and scrotum. [16,18] HG in esophagus is commonly located in cervical portion (proximal quarter) and is often referred as "Inlet patch." ...
Background: Usually, communicable/infectious diseases pose a public health problem as epidemic or endemic diseases, but sometimesnoncommunicable diseases can create acute or chronic health hazards. One such example is choristoma. Choristoma/heterotropia(Ht)/ectopia refers to normal tissue at an abnormal location having no neural or vascular or direct connection with the orthotropic tissue. Often,they are asymptomatic and are inconsequential hence need no specific treatment. However, it can become symptomatic when they are largerin size causing dreaded surgical emergencies. Aims and Objectives: To analyze clinicoradiological and histopathological picture of differenttypes of choristoma/Hts with its treatment modalities. Materials and Methods: A hospital-based prospective study of nine different kindsof Ht cases (n) were keenly reviewed during 2 years’ period along with all demographic and radiologic data, treatment history, and follow-uphistory. Histopathology was supplemented by special stains and immunohistochemistry (IHC). Results: Out of nine cases, four were female,five male, and three children. The types of Ht were sebaceous, gastric, pancreatic, adrenocortical, and glial ectopic tissues located in differentsites such as nasal cavity (n = 1), esophagus (n = 2), duodenum (n = 2), Meckel’s diverticulum (n = 3), and testis (n = 1). Histopathology ofeach type was reviewed extensively with most recent literature studies and was supplemented by special stains (periodic acid–Schiff [PAS],PAS-D, AL-PAS, Masson’s trichrome) and IHC (glial fibrillary acidic protein, S100, CK7, synaptophysin, chromogranin). Conclusion: Htcan occur in any part of the body and can be of any tissue origin; only high index suspicion of such an entity followed by histopathologicalconfirmation can lead to subsequent definitive management .
... The word heterotopia is derived from the Greek language, which refers to tissues that are found in an unusual place [1]. Gastric heterotopia (GH) is an uncommon, benign, congenital condition characterized by the presence of gastric tissue outside of the stomach [2,3]. ...
... Gastric heterotopia (GH) is an uncommon, benign, congenital condition characterized by the presence of gastric tissue outside of the stomach [2,3]. It can be found throughout the gastrointestinal (GI) tract and usually occurs in the form of polyps, nodules, or tumorous growths [1][2][3]. In the duodenum, GH is most commonly seen in the duodenal bulb in the form of multiple polyps in approximately 0.5 to 2% of the general population [2,4]. ...
Gastric heterotopia (GH) is a rare, congenital condition where gastric tissue is found outside of its normal location in the gastric mucosa. It is usually benign and can be found throughout the gastrointestinal (GI) tract. In the duodenum, it is usually seen as multiple polyps, specifically in the duodenal bulb. Here, we discuss the case of a 67-year-old male patient who presented with hematemesis, melena, and abdominal pain. Esophagogastroduodenoscopy (EGD) and biopsy revealed a mass consisting of heterotopic gastric mucosa along with an esophageal ulcer. In this article, we will discuss the literature related to the clinical presentation, diagnosis, and management of GH.
... The pathogenesis of GH remains uncertain with some authors suggesting that, it is a consequence of a reparative process of damaged bowel mucosa, while some others hypothesising it to be the result of abnormal differentiation of local pluripotent endodermal stem cells. 19 The incidence of heterotopic gastric mucosa in EDCs ranges from 17% to 36%. 20 21 Clinical presentation of EDC is variable and depends on the size, location and type of mucosal lining. ...
... EDC with GH can present with chronic long standing anaemia due to malena. 19 Rarely, it may be associated with complications like perforation, intussusceptions, obstruction, 19 In our case, the child presented with pain in abdomen, anaemia and subacute intestinal obstruction. In the course of hospital stay, he developed contained perforation, which required emergency surgery. ...
... EDC with GH can present with chronic long standing anaemia due to malena. 19 Rarely, it may be associated with complications like perforation, intussusceptions, obstruction, 19 In our case, the child presented with pain in abdomen, anaemia and subacute intestinal obstruction. In the course of hospital stay, he developed contained perforation, which required emergency surgery. ...
Enteric duplication cysts (EDCs) are congenital malformations of the gastrointestinal tract. EDCs can present as tubular or spherical cystic lesions of the abdomen. The tubular variant of EDC arises as an outpouching from the bowel wall, whereas the spherical variant rarely shows bowel communication. EDCs are known to harbour heterotopic pancreatic parenchyma or gastric mucosa. We present a case of EDC of the ileum (tubular type) with heterotopic gastric mucosa in a 7-year-old child who came with malena and abdominal discomfort. CT revealed focal abnormal dilatation of the ileal loop with polypoidal mucosal thickening. Differential diagnosis of lymphoma, bowel polyps and Meckel's diverticula with gastric heterotopia (GH) were considered. Subsequent surgery followed by histopathology revealed it to be EDC with GH. We discuss this case to familiarise radiologists with the atypical imaging features of EDC, to prevent misdiagnosis and initiate prompt treatment in appropriate clinical settings. BACKGROUND
... 2 Clinical presentations of HGM, such as intestinal obstruction, bleeding, perforation, and fistula formation to adjacent structures, vary and depend on the location and size. 3 It has also been reported that solitary large HGMs may be difficult to differentiate from malignant neoplasms such as carcinomas 4 ; however, a differential diagnosis for it has yet to be established. Excessive surgery should be avoided because HGM is essentially a benign entity. ...
In this case, Esophagogastroduodenoscopy showed an approximately 25‐mm diameter annular and polypoid mucosa at the opposite side of Pylorus ring in first part of duodenum. The biopsy specimens were diagnosed with the heterotopic gastric mucosa (HGM) pathologically. This is a rare presentation of annular and polypoid HGM in duodenum. This may indicate the needs for other documents as well as analysis regarding the mechanism for the development of HGM in duodenum.
... In most cases, HGM remains asymptomatic. Nevertheless, it may result in several complications such as gastrointestinal bleeding and intestinal obstruction [8,9]. Rarely, it can act as the lead point for intussusception. ...
... HGM has been reported anywhere throughout the length of the gastrointestinal tract [8][9][10][11][12][13]. Its occurrence in the small intestine is rare unless associated with remnants of Meckel's diverticulum. ...
... Clinical presentation of HGM varies and depends on the location and size of the heterotopic tissue. The most common complication of HGM is intestinal mucosal ulceration with gastrointestinal bleeding [8,9]. It can also form an intraluminal mass causing intestinal obstruction. ...
Intussusception is the leading cause for intestinal obstruction in children. However, it accounts for only 5% of bowel obstructions in adults. Heterotopic gastric mucosa (HGM) can occur anywhere in the gastrointestinal tract; nevertheless, its occurrence in the small intestine is rare unless associated with remnants of vitelline duct (Meckel's diverticulum). Herein, we describe a case of a 33-year-old male who presented with symptoms and signs of intestinal obstruction caused by ileo-colic intussusception, in which polypoid HGM acted as the organic lead point for intussusception. Several cases of intussusception caused by HGM have been reported in pediatric age group; however, this event is exceedingly rare in adults.
... In most reported cases of gastric heterotopia involving the jejunum (Table 1), patients had a median age of 21.5 years with the youngest patient being one-year-old [6]. Presenting symptoms consisted of gastrointestinal bleeding [7][8][9] or obstructive symptoms as a result of a polypoid mass [1,5,[10][11][12][13][14][15][16][17] and stricture [2,3,6]. One case report described a 16-year-old patient who developed perforation and ulceration involving the jejunum in the setting of gastric heterotopia [18]. ...
Heterotopia is the presence of normal physiologic tissue in an atypical location. Gastric heterotopia has been described in various locations throughout the gastrointestinal tract, including the small intestine. Gastric heterotopia of the small intestine typically is asymptomatic but may present in several ways with symptoms of obstruction, bleeding, perforation, intussusception, or pain. However, gastric heterotopia is rare beyond the duodenum except for its frequent association with Meckel's diverticulum. This entity should be considered in the differential diagnosis of polypoid lesions presenting with symptoms of bleeding or obstruction especially in younger patients. We present a case of gastric heterotopia of the jejunum in a patient with a prior history of Meckel's diverticulectomy after he presented with obstructive symptoms. His symptoms improved following resection of two jejunal polyps via antegrade double-balloon assisted enteroscopy with fluoroscopy. On histopathlogical examination, findings were consistent with gastric heterotopia. This case highlights the importance of considering gastric heterotopia in the differential diagnosis of polypoid lesions located beyond the ligament of Treitz in younger patients presenting with obstructive symptoms.
Background
Heterotopic gastric mucosa has been scarcely reported in the veterinary literature. Its presence can be asymptomatic or associated with various clinical signs ranging from apathy, vomiting, to abdominal pain. This report illustrates the presence of heterotopic gastric mucosa in the jejunum of an adult dog. It is the first to describe severe anemia, requiring acute blood transfusion, following intestinal hemorrhage caused by heterotopic gastric mucosa.
Case presentation
A twelve-year-old, intact male Maltese dog was presented with a history of apathy, vomiting and anemia. The dog was on a strict diet for recurrent diarrhea, food intolerance and skin allergy. Clinical examination revealed severe anemic mucous membranes and painful abdominal palpation. Blood examination confirmed severe regenerative anemia. Ultrasonography showed an intestinal neoplasm, gall bladder sludge and non-homogeneous liver parenchyma. Three-view thoracic radiographs failed to show any metastatic lesions or enlarged lymph nodes. After initial stabilization and blood transfusion, a midline exploratory laparotomy was performed. Three different masses were found in the jejunum. Resection and anastomosis of approximately 40 cm of jejunum was performed, followed by liver and lymph node biopsy and placement of an esophagostomy tube. Two days after surgery the dog started to clinically improve and was discharged from the hospital on the sixth day after surgery. Histopathology revealed the intestinal masses to be heterotopic gastric mucosa associated with intramural cystic distensions, multifocal ulceration and bleeding into the intestinal lumen. Two years after surgery, the dog did not have a recurrence of anemia or gastrointestinal signs.
Conclusions
This case demonstrates that heterotopic gastric mucosa can be considered one of the differential diagnoses in case of severe anemia due to gastrointestinal hemorrhage and suspected intestinal tumors. Although in most described cases in literature the finding seems to be incidental on necropsy, our report shows that heterotopic gastric mucosa can be the etiology of life-threatening signs. In addition, because no recurrent diarrhea episodes occurred after surgical resection of the ectopic tissue, it is likely that the heterotopic gastric mucosa was the cause of the food intolerance signs in this dog.
A 14-year-old male presented with worsening chronic intermittent abdominal pain, mild anemia, positive fecal occult blood test, and elevated calprotectin. Computerized tomography and magnetic resonance imaging showed ileal dilation with mucosal enhancement and inflammatory changes suspicious for inflammatory bowel disease (IBD). Prominent mucosal folds were suggestive of gastric heterotopia, but Meckel's scan was negative. Upper endoscopy, colonoscopy, and double balloon enteroscopy were grossly and microscopically normal. Laparotomy revealed 17 cm of a dense, inflamed, stenotic segment of ileum. The strictured ileum had perforated and had been concealed by an adjacent loop of small bowel, ultimately producing an obstructive IBD-like picture, but was found to be histologically consistent with gastric oxyntic mucosa. This case illustrates the challenges of diagnosing and treating heterotopic gastric mucosa, and the importance of considering diagnoses other than IBD when evaluating stricturing disease of the small bowel.
