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.