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Heterotopic Gastric Mucosa of the Rectum UCTN Heterotopic Gastric Mucosa of the Rectum UCTN Heterotopic gastric mucosa (HGM), which P. De Angelis1, A. Trecca2, P. Francalanci3, results from embryonic tissue displace- F. Torroni1, G. Federici di Abriola1, ment, can be found throughout the length B. Papadatou4, G. C. Ciofetta5, of the gastrointestinal tract. Heterotopic L. DallOglio1 gastric mucosa in the rectum is uncom- 1 Surgical and Endoscopic Digestive Unit, mon, and few cases have been described Ospedale Pediatrico Bambino Ges, Unusual Cases and Technical Notes in children [1±3]. Rome, Italy 2 Endoscopic and Gastroenterologic We report a case of a child of 4.5 years Operative Unit ªFabio di Giovanbattistaº, with recurrent rectal bleeding, tenesmus, UEGO FDG, Rome, Italy diarrhea, and abdominal pain. He under- 3 Department of Pathology, Ospedale went colonoscopy, which showed an ulcer Pediatrico Bambino Ges, Rome, Italy of diameter 1 cm covered by a whitish 4 Department of Gastroenterology, membrane, 15 cm from the anal verge. Ospedale Pediatrico Bambino Ges, Histological findings confirmed a solitary Rome, Italy rectal ulcer. The child apparently respon- Figure 1 Sessile polypoid lesions, seen with 5 Nuclear Medicine Unit, Ospedale ded well to medical therapy with mesal- the endoscope in retroversion. Pediatrico Bambino Ges, Rome, Italy. amine enema, but the abdominal pain and diarrhea with bleeding recurred. Co- References lonoscopy showed two sessile polypoid lesions, 1.5 cm in diameter, on the poster- 1 Wiersma R, Hadley GP, Govender D, ior rectal wall, within 5 cm from the anal Grant HW. Rectal gastric heterotopia in verge (Figure 1). Histological examination infancy. J Pediatr Surg 2002; 37: 1481± of biopsies revealed colonic mucosa asso- 1482 ciated with gastric corpus-fundic mucosa 2 Taylor AL. The epithelial heterotopias of 927 (Figure 2). A definitive diagnosis of het- the alimentary tracts. J Pathol Bacteriol erotopic gastric mucosa was made. On 1927; 30: 415±449 scintigraphy, there was increased uptake 3 Devereaux CE, Devereaux RG. of 99mTc-pertechnetate in the stomach Heterotopic gastric mucosa of the rec- and in the rectum. Omeprazole (1 mg/kg tum with a review of the literature. J per day) promptly resolved the clinical Figure 2 Histological appearance showing Clin Gastroenterol 1994; 19: 41±45 features with healing of the rectal ulcer colonic mucosa (goblet cells) associated with 4 Murray FE, Lombard M, Dervan P et al. [4]. Endoscopic ultrasound (Olympus EU- gastric corpus-fundic mucosa (gastric glands Bleeding from multifocal heterotopic with parietal and principal cells). (Hematoxy- M30S ultrasonic generator and Olympus gastric mucosa in the colon controlled lin and eosin (H&E); original magnifica- UM-3R 20 MHz ultrasonic radial mini- tion 5.) by an H2 antagonist. Gut 1988; 29: probe; Olympus, Tokyo, Japan) confirmed 848±851 thickening of the mucosal layer without 5 Panigrahi D, Johnson AN, Wosu NJ. Ade- deeper infiltration. nocarcinoma arising from gastric het- Endoscopic excision is one of the suggest- erotopia in the jejunal mucosa of a bea- Mucosectomy was carried out 8 months ed treatments for this condition, especial- gle dog. Vet Pathol 1994; 31: 278±280 after diagnosis with a dentate electrocau- ly in children, to warrant normal growth tery snare (Olympus SD-16U), in retrover- and to avoid malignant degeneration [5]. sion, aided by chromoendoscopy with Since this type of lesion can occur any- Corresponding Author 0.5% methylene blue, which confirmed where in the alimentary tract, long-term heterotopic gastric mucosa and defined follow-up of all patients is recommended. P. De Angelis, M.D. the borders of the lesion. Endoscopy after Surgical and Endoscopic Digestive Unit, 6±12 months demonstrated absence of Ospedale Pediatrico Bambino Ges heterotopic gastric mucosa. After 24 Piazza S. Onofrio, 4 months, a residual area of heterotopic 00165 Rome gastric mucosa was found and removed. Italy Fax: +39-06-68592543 E-mail: [email protected] De Angelis P et al. Heterotopic Gastric Mucosa of the Rectum ´ Endoscopy 2004;36: 927.
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