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Milla Salguero SE, Medina EA, Hause Murillo A, Perdomo Domínguez ES. Perforation of Meckel's diverticulum by an unusual foreign body: A case report and a review of literature. Clin Case Rep 2024; 12:e9183. [PMID: 39081826 PMCID: PMC11286536 DOI: 10.1002/ccr3.9183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/30/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Key Clinical Message Perforation of Meckel's diverticulum (MD) is rare, particularly by foreign body. High index of suspicion and thorough intraoperative assessment is needed in patients undergoing surgery for acute appendicitis, specifically when appendix appears normal. Abstract Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. While often asymptomatic, it can present with several complications. Perforation due to foreign body ingestion is rare but can have severe consequences if late diagnosis occurs. A 13-year-old male, initially suspected of acute appendicitis, was eventually diagnosed with perforation of MD by a wood splinter-like foreign body after intraoperative assessment. Histological analysis revealed ectopic colonic tissue within the MD, a finding whose implications are not well understood, in contrast with the well-established complications associated with ectopic gastric and pancreatic tissues. This case highlights the diagnostic challenges of MD, which can mimic acute appendicitis, emphasizing the need for high suspicion when faced with atypical clinical presentation such as foreign body-induced perforation. Although surgical resection of asymptomatic MD remains controversial, we recommend a case-specific approach based on risk factors to guide decision-making on surgical resection for asymptomatic MD.
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Affiliation(s)
| | - Enrique Adalberto Medina
- Department of Pediatrics, Hospital Mario Catarino RivasUniversidad Nacional Autónoma de Honduras (UNAH)San Pedro SulaHonduras
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2
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D'Sa S, Mziray-Andrew C, Porayette P. An Unusual Case of Gastric Heterotopia Presenting as Rectal Prolapse. ACG Case Rep J 2024; 11:e01250. [PMID: 38274300 PMCID: PMC10810580 DOI: 10.14309/crj.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Heterotopic gastric mucosa (HGM) involving the rectum is an uncommon finding. It is especially rare in young children. Rectal prolapse is an uncommon presentation of HGM. We report a case of HGM in the rectum of a 2-year-old previously healthy girl, who presented with rectal prolapse and painless bleeding. Endoscopic mucosal resection was performed to completely resect the lesion after the patient failed to respond to proton pump inhibitors. This case underscores the importance of considering HGM involving the rectum as a cause of rectal prolapse in young pediatric patients.
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Affiliation(s)
- Saskia D'Sa
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL
| | - Charmaine Mziray-Andrew
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL
- Division of Pediatric Gastroenterology, Southern Illinois University School of Medicine, Springfield, IL
| | - Prashanth Porayette
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL
- Division of Pediatric Gastroenterology, Southern Illinois University School of Medicine, Springfield, IL
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3
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Park JG, Suh JI, Kim YU. Gastric heterotopia of colon found cancer workup in liver abscess: A case report. World J Clin Cases 2022; 10:5012-5017. [PMID: 35801043 PMCID: PMC9198881 DOI: 10.12998/wjcc.v10.i15.5012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/18/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recently reported cases of pyogenic liver abscess associated with colonic cancer in the absence of underlying disease, have included a small number of cases of gastric heterotopia (GHT). GHT is a congenital anomaly composed of ectopic gastric mucosa and can occur anywhere in the gastrointestinal tract but is more frequently encountered in the cervical esophagus. However, it is rarely observed in colon. Furthermore, most reported cases of GHT of the colon involved the rectum, and GHT involving the colon proximal to the rectum is rare.
CASE SUMMARY An 83-year-old male patient presented with fever and a diagnosis of pyogenic liver abscess. Colonoscopy was performed for colon cancer workup and revealed a 1.0 cm sized polyp at the transverse colon. The polyp was removed by endoscopic mucosal resection by monopolar electrocauterization using a snare. Pathological examination revealed GHT. After administering intravenous antibiotics, the patient recovered well.
CONCLUSION GHT in the colon could affect the development of pyogenic liver abscess by enabling hematogenous propagation of Klebsiella pneumoniae through mucosal damage. However, more study is needed due to the lack of cases.
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Affiliation(s)
- Jun Gi Park
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, South Korea
| | - Jeong Ill Suh
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, South Korea
| | - Yeo Un Kim
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, South Korea
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4
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Galassi L, Guerrazzi G, Romeo BG, Magni M, Tagliabue F, Mariani P. Gastric Mucosa Heterotopia in Distal Rectum: a Case Report and Narrative Literature Review. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1469-1476. [DOI: 10.1007/s42399-021-00897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 01/05/2025]
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5
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Ali SM, Ahmed AA, Saaid LAH, Mohamed GMK, Shah AA, Al-Tarakji M, Aftab Z, Inamulla, Rashid S. Heterotopic Gastric Mucosa Presenting as Lower Gastrointestinal Bleeding: An Unusual Case Report. Case Rep Surg 2019; 2019:5791984. [PMID: 31956463 PMCID: PMC6949661 DOI: 10.1155/2019/5791984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/13/2019] [Indexed: 01/02/2023] Open
Abstract
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. Very few cases are published in literature. We describe a case of young male who presented with an episode of large amount of melena, from a bleeding jejunal lesion, diagnosed by endoscopy. Laparotomy and wedge resection of the jejunal lesion was done, and histopathology showed gastric heterotopia in a small jejunal diverticulum.
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Affiliation(s)
| | | | | | | | - Amjad Ali Shah
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Zia Aftab
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Inamulla
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sameera Rashid
- Department of Pathology, Hamad Medical Corporation, Doha, Qatar
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6
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Chen WG, Zhu HT, Yang M, Xu GQ, Chen LH, Chen HT. Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum: Clinical experience and endoscopic management. World J Gastroenterol 2018; 24:3462-3468. [PMID: 30122884 PMCID: PMC6092586 DOI: 10.3748/wjg.v24.i30.3462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Wen-Guo Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hua-Tuo Zhu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ming Yang
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li-Hua Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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7
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Mannan AASR, Vieth M, Khararjian A, Khandakar B, Lam-Himlin D, Heydt D, Bhaijee F, Venbrux HJ, Byrnes K, Voltaggio L, Barker N, Yuan S, Montgomery EA. The outlet patch: gastric heterotopia of the colorectum and anus. Histopathology 2018; 73:220-229. [DOI: 10.1111/his.13632] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Abul A S R Mannan
- Department of Pathology; The Johns Hopkins Hospital; Baltimore MD USA
| | - Michael Vieth
- Institute of Pathology; Klinikum Bayreuth; Bayreuth Germany
| | - Armen Khararjian
- Department of Pathology; The Johns Hopkins Hospital; Baltimore MD USA
| | | | | | | | | | - Henry J Venbrux
- Jackson Siegelbaum Gastroenterology and PAGI; Camp Hill PA USA
| | - Kathleen Byrnes
- Department of Pathology; The Johns Hopkins Hospital; Baltimore MD USA
| | | | - Norman Barker
- Department of Pathology; The Johns Hopkins Hospital; Baltimore MD USA
| | - Songyang Yuan
- Mount Sinai Beth Israel Medical Center; New York NY USA
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Anand P, Singh S, Sarin N. Intussusception caused by heterotopic gastric mucosa in small intestine: a case report. J Med Case Rep 2017; 11:258. [PMID: 28893301 PMCID: PMC5594578 DOI: 10.1186/s13256-017-1425-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/14/2017] [Indexed: 02/02/2023] Open
Abstract
Background Intestinal intussusception is the most frequent cause of small bowel obstruction in children between the ages of 2 months and 5 years and often remains idiopathic in etiology, even after surgery. On microscopic examination, in intussusception normal mucosa is noted but in a few cases heterotopic tissue can be seen. Heterotopic gastric mucosa in the small intestine is extremely rare except for its occurrence in remnants of Meckel’s diverticulum. In view of the rarity of this condition, we report a case of ectopic gastric mucosa in the small intestine that was not associated with remnants of vitelline duct. Case presentation A 6-year-old boy of Indo-Aryan ethnicity from India presented with episodes of acute abdominal pain and distension with vomiting and non-passage of stools. On ultrasonography intussusception was suspected. A laparotomy was done and the ileal segment (tip of intussusception) was sent for histopathological examination. On histopathology, sections from the tip of intussusception showed extensive gastric metaplasia of the mucosa. Conclusions A definitive diagnosis of heterotopic gastric mucosa is established by histopathological examination and it is important to differentiate heterotopia, which is a developmental anomaly, from metaplasia, which is an acquired condition. Heterotopic gastric mucosa is usually clinically silent and surgical intervention can be considered in patients with complications such as gastrointestinal hemorrhage and intestinal obstruction.
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Affiliation(s)
- Priyanka Anand
- Department of Pathology, NDMC and Hindu Rao Hospital, Malka Ganj, New Delhi, 110007, India
| | - Sompal Singh
- Department of Pathology, NDMC and Hindu Rao Hospital, Malka Ganj, New Delhi, 110007, India.
| | - Namrata Sarin
- Department of Pathology, NDMC and Hindu Rao Hospital, Malka Ganj, New Delhi, 110007, India
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Soares J, Ferreira C, Marques M, Corujeira S, Tavares M, Lopes J, Carneiro F, Amil Dias J, Trindade E. Endoscopic Mucosectomy in a Child Presenting with Gastric Heterotopia of the Rectum. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 24:288-291. [PMID: 29255771 DOI: 10.1159/000478939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/10/2017] [Indexed: 12/26/2022]
Abstract
Gastric mucosal heterotopia has been described in all levels of the gastrointestinal tract. Its occurrence in the rectum is uncommon. We report the case of a 4-year-old boy referred to Pediatric Gastroenterology for intermittent rectal bleeding for the past 2 years. Total ileocolonoscopy revealed a flat, well-circumscribed lesion of 4 cm, with elevated margins, localized at 10 cm from the anal verge. Histologic examination showed typical gastric mucosa of the oxyntic type. Treatment with proton pump inhibitors was started without resolution of the symptoms and, therefore, an endoscopic mucosal resection was performed. Heterotopic gastric mucosa represents a rare cause of rectal bleeding in children and endoscopic evaluation is fundamental for diagnosis. Although not usually performed in pediatric ages, endoscopic mucosectomy allows complete resolution of the problem avoiding surgery.
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Affiliation(s)
- Joana Soares
- Serviço de Pediatria, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - Carla Ferreira
- Serviço de Pediatria, Hospital Senhora da Oliveira, Guimarães, EPE, Guimarães, Portugal
| | - Margarida Marques
- Serviço de Gastroenterologia, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Susana Corujeira
- Serviço de Pediatria, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Marta Tavares
- Serviço de Pediatria, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Joanne Lopes
- Serviço de Anatomia Patológica, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Fátima Carneiro
- Serviço de Anatomia Patológica, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Jorge Amil Dias
- Serviço de Pediatria, Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Eunice Trindade
- Serviço de Pediatria, Centro Hospitalar de São João, EPE, Porto, Portugal
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10
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Salem GA, Fazili J, Ali T. Gastric heterotopia in the rectum. A rare cause of ectopic gastric tissue. Arab J Gastroenterol 2017; 18:42-43. [PMID: 28223104 DOI: 10.1016/j.ajg.2017.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/22/2016] [Accepted: 01/22/2017] [Indexed: 02/08/2023]
Abstract
Gastric heterotopia refers to the discovery of normal gastric tissue at foreign, unexpected sites. It has been described anywhere in the alimentary tract, even in the mediastinum, scrotum, and spinal cord. It is not uncommonly seen in the oesophagus or small intestine. However, large bowel lesions are rare, with the most common location of colonic lesions is the rectum. Although it is a rare entity, it may be the source for significant problems such as rectal bleeding, abdominal pain, deep rectal pain, and malignancy. Here, we report an additional case of gastric heterotopia in the rectum of a 56year old gentleman, and review the literature.
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Affiliation(s)
- George A Salem
- Department of Medicine, Section of Nutrition and Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Javid Fazili
- Department of Medicine, Section of Nutrition and Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tauseef Ali
- Department of Medicine, Section of Nutrition and Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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11
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Dinarvand P, Vareedayah AA, Phillips NJ, Hachem C, Lai J. Gastric heterotopia in rectum: A literature review and its diagnostic pitfall. SAGE Open Med Case Rep 2017; 5:2050313X17693968. [PMID: 28321304 PMCID: PMC5347492 DOI: 10.1177/2050313x17693968] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/23/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives: The term heterotopia, in pathology, refers to the presence of normal tissues at foreign sites. Gastric heterotopia has been reported anywhere in the gastrointestinal tract. However, the presence of gastric heterotopia in the rectum is very rare. Methods: We, here, report a rare case of a localized 2-cm area of cratered mucosa with heaped-up borders in the rectum of a 51-year-old, asymptomatic woman who underwent screening colonoscopy. Results: Histologic examination of the biopsy from the lesional tissue in rectum demonstrated fragments of rectal mucosa co-mingling with oxyntic- and antral-type gastric mucosa. No intestinal metaplasia or Helicobacter pylori is identified. Conclusion: Patients with gastric heterotopia in rectum usually present with bleeding and/or abdominal pain. Definite treatment of choice is surgical or endoscopic resection, although the lesions also respond to histamine-2 receptor blockers. In this article, most recent literature about gastric heterotopia in rectum is reviewed, following a case presentation about it.
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Affiliation(s)
- Peyman Dinarvand
- Department of Pathology, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Ashley A Vareedayah
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Nancy J Phillips
- Department of Pathology, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Christine Hachem
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Jinping Lai
- Department of Pathology, School of Medicine, Saint Louis University, St. Louis, MO, USA
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12
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Iacopini F, Gotoda T, Elisei W, Rigato P, Montagnese F, Saito Y, Costamagna G, Iacopini G. Heterotopic gastric mucosa in the anus and rectum: first case report of endoscopic submucosal dissection and systematic review. Gastroenterol Rep (Oxf) 2016; 4:196-205. [PMID: 27103738 PMCID: PMC4976682 DOI: 10.1093/gastro/gow006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Heterotopic gastric mucosa (HGM) is the most reported epithelial heterotopia, but it is very rare in the rectum and anus. METHODS The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection (ESD) is reported. The systematic review was based on a comprehensive search of MEDLINE, EMBASE and Google Scholar. Studies on humans were identified with the term 'heterotopic gastric mucosa in the rectum and /or anus.' RESULTS The search identified 79 citations, and 72 cases were evaluated comprising the present report. Congenital malformations were observed in 17 (24%) patients; rectal duplication accounted for most of the cases. The HGM was located in the anus and perineal rectum in 25 cases (41%) and low, middle and proximal pelvic rectum in 20 (33%), five (8%) and 11 cases (18%), respectively. Morphology was nonpolypoid in 37 cases (51%), polypoid in 26 cases (36%) and ulcerated in nine cases (13%). Specific anorectal symptoms were reported by 50 (69%) patients of the whole study population, and by 33 (97%) of 34 patients ≤ 18 years. Complications were observed in 23 cases (32%). The HGM was excised in 50 cases (83%). Endoscopic resection was performed in 17 cases (34%); resection was piecemeal in five of 12 lesions ≥15 mm, required argon plasma coagulation in two cases and was associated with residual tissue in two (17%). Intestinal metaplasia and an adenoma with low-grade dysplasia were described in three adults (4%). DISCUSSION This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications, mainly in the pediatric population, and a risk of malignancy in adults. Its complete excision should be recommended, and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.
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Affiliation(s)
- Federico Iacopini
- Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe, Albano L., Rome, Italy
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Walter Elisei
- Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe, Albano L., Rome, Italy
| | | | - Fabrizio Montagnese
- Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe, Albano L., Rome, Italy
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Guido Costamagna
- Digestive Endoscopy Unit, Policlinico Gemelli, Catholic University, Rome, Italy and
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13
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Al-Hussaini A, Lone K, Al-Sofyani M, El Bagir A. Gastric heterotopia of rectum in a child: a mimicker of solitary rectal ulcer syndrome. Ann Saudi Med 2014; 34:245-9. [PMID: 25266186 PMCID: PMC6074586 DOI: 10.5144/0256-4947.2014.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Bleeding per rectum is an uncommon presentation in pediatric patients. Heterotopic gastric mucosa in the rectum is a rare cause of rectal bleeding. Here, we report a 3-year-old child with a bleeding rectal ulcer that was initially diagnosed and managed as a solitary rectal ulcer syndrome. After 1 month, the patient persisted to have intermittent rectal bleed and severe anal pain. Repeat colonoscopy showed the worsening of the rectal ulcer in size. Pediatric surgeon excised the ulcer, and histopathological examination revealed a gastric fundic-type mucosa consistent with the diagnosis of gastric heterotopia of the rectum. Over the following 18 months, our patient had experienced no rectal bleeding and remained entirely asymptomatic. In conclusion, heterotopic gastric mucosa of the rectum should be considered in the differential diagnosis of a bleeding rectal ulcer.
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Affiliation(s)
- Abdulrahman Al-Hussaini
- Dr. Abdulrahman Al-Hussaini, Riyadh Medical Complex,, Children's Hospital,, King Fahad Medical City,, PO Box 7153 Riyadh 11462,, Saudi Arabia,
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14
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Ko H, Park SY, Cha EJ, Sohn JS. Colonic adenocarcinoma arising from gastric heterotopia: a case study. KOREAN JOURNAL OF PATHOLOGY 2013; 47:289-92. [PMID: 23837024 PMCID: PMC3701827 DOI: 10.4132/koreanjpathol.2013.47.3.289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/07/2012] [Accepted: 09/11/2012] [Indexed: 01/01/2023]
Abstract
Heterotopic gastric mucosa occurs in all areas of the gastrointestinal tract including the nasopharynx, tongue, esophagus, small intestine, colon, and rectum. Gastric heterotopia of the large bowel is infrequent, and most cases have been reported in the rectum. Review of the literature has revealed only eight cases involving the colon proximal to the rectum. Little is known of the natural history of gastric heterotopias, except that. It usually presents with gastrointestinal bleeding, though other serious complications such as bowel perforation, intussusceptions, and fistula formation, are possible. Further, it is unclear whether heterotopic gastric mucosa progresses to malignancy. Herein, we describe a case of adenocarcinoma of the transverse colon arising from gastric heterotopia. To the best of our knowledge, this is the first report of adenocarcinoma arising from heterotopic gastric mucosa in the colon.
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Affiliation(s)
- Hyoungsuk Ko
- Department of Pathology, Konyang University School of Medicine, Daejeon, Korea
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15
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Reis H, Kerker J, Schaefer A, Budde T, Schmid KW, Metz KA. [Heterotopic gastric mucosa of the rectum. Case report with literature review]. DER PATHOLOGE 2012; 32:521-3. [PMID: 21732079 DOI: 10.1007/s00292-011-1461-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heterotopic gastric mucosa is a rare finding in the rectum. Apart from two other hypotheses, a misdifferentiation of entodermal stem cells is the most widely accepted aetiopathogenetic assumption today. Due to acid secretion, the lesions predominantly manifest with hematochezia. Therapeutic options include medicinal therapy and particularly (endoscopic) removal. From the pathologist's point of view a careful evaluation is required also in terms of basically possible dysplastic or malignant changes.
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Affiliation(s)
- H Reis
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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16
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Colonic-type adenocarcinoma of the base of the tongue: a case report of a rare neoplasm. Head Neck Pathol 2011; 6:250-4. [PMID: 21948243 PMCID: PMC3370020 DOI: 10.1007/s12105-011-0301-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/10/2011] [Indexed: 10/17/2022]
Abstract
Lingual adenocarcinomas (ADC), either primary or metastatic to the tongue are extraordinarily rare neoplasms. Primary lingual adenocarcinomas are primarily of minor salivary gland origin. Two cases of primary colonic-type adenocarcinomas of the base of the tongue were recently reported for the first time in the English literature. We present an additional case of lingual intestinal-type adenocarcinoma with mucinous features that occurred in association with cervical node metastasis and discuss the clinicopathologic features and histogenetic aspects of this rare entity.
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