Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2018; 24(30): 3462-3468
Published online Aug 14, 2018. doi: 10.3748/wjg.v24.i30.3462
Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum: Clinical experience and endoscopic management
Wen-Guo Chen, Hua-Tuo Zhu, Ming Yang, Guo-Qiang Xu, Li-Hua Chen, Hong-Tan Chen
Wen-Guo Chen, Hua-Tuo Zhu, Ming Yang, Guo-Qiang Xu, Li-Hua Chen, Hong-Tan Chen, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Chen WG wrote the paper; Zhu HT collected and analyzed the data; Yang M performed the research; Xu GQ and Chen LH were study supervisors; Chen HT conceived and designed the study; all the authors approved the final version of the article to be published.
Supported by the National Natural Science Foundation of China, No. 81600413 and No. 81600414.
Informed consent statement: Written informed consent was provided by the patient prior to study inclusion. All details that might disclose the identity of the subject were omitted or anonymized.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Tan Chen, MD, Chief Doctor, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun road, Hangzhou 310003, Zhejiang Province, China. 1510026@zju.edu.cn.
Telephone: +86-571-87236729 Fax: +86-571-87236611
Received: May 25, 2018
Peer-review started: May 26, 2018
First decision: July 6, 2018
Revised: July 9, 2018
Accepted: July 16, 2018
Article in press: July 16, 2018
Published online: August 14, 2018
Abstract

Heterotopic gastric mucosa (HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge. In the present study, a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia. Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum. Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum. Narrow band imaging further confirmed the histological results. Endoscopic ultrasound indicated that the lesion originated from the mucosal layer, and partially involved the submucosal layer. Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion. No bleeding, perforation or other adverse events were observed. The presence of HGM in the diverticular cavity greatly increased the surgical difficulty. A literature review was also carried out in our study.

Keywords: Endoscopic submucosal dissection, Rectum, Helicobacter pylori, Endoscopy, Heterotopic gastric mucosa

Core tip: Heterotopic gastric mucosa (HGM) in the rectum is an extremely rare clinical entity with unclear pathogenesis and no standard guidelines regarding optimal treatment. We present a patient with HGM and a concomitant diverticulum in the rectum, indicated its endoscopic ultrasound and narrow band imaging characteristics. Endoscopic submucosal dissection (ESD) was performed in this patient due to the large size and shape of the lesion. This is the first report of the resection of HGM and a concomitant diverticulum by ESD. A literature review was also carried out to investigate the clinical characteristics, diagnosis and management of HGM in the rectum.