To the Editor,
Heterotopic gastric mucosa (HGM) is usually a clinically asymptomatic benign lesion. The incidence of this lesion usually diagnosed incidentally is around 2%, and it is more common in the adult population. Congenital remnants of gastric mucosa can be seen anywhere in the gastrointestinal tract (such as the esophagus, duodenum, small intestine, and Meckel's diverticulum), but ileum localization is rare. HGM located in the ileum is usually in the form of a polypoid mass smaller than 1 cm, attached to the intestinal wall on the mesentery surface of the intestine (1).
Although HGM is seen mainly in the esophagus, duodenum, and Meckel's diverticulum, it is rarely in the jejunum and ileum. Most jejunal and ileal HGMs are diagnosed by samples of histological results after surgery. HGM is usually in the form of an entrance patch in the upper 1/3 of the esophagus; It is seen as nodular and jejunal masses in the duodenum and as polypoid masses in the ileum (2).
HGM may be congenital or acquired, but its formation is unknown. Acquired HGM occurs when gastric mucosa epithelium is affected by the effect of inflammatory or peptic processes. HGM is usually clinically silent and does not require treatment; however, surgical intervention may be required after complications such as bleeding and intestinal obstruction. Therefore, HGM of the ileum is extremely rare. Diagnosis of ileal polypoid lesions is important in affecting gastric mucosal epithelium (3).
In this study (patient informed consent form was obtained), a ten-year-old girl with complaints of abdominal pain and vomiting referred to our clinic with a preliminary diagnosis of intussusception as a result of ultrasonography (US) performed in a private medical center. When he applied to our clinic, the patient did not have acute abdomen findings in the examination and did not have a palpable mass. Her complaints of pain regressed and his vomiting stopped. In the standing direct abdominal X-ray (Figure 1), air-fluid levels, which is the radiological finding of intestinal obstruction, and on repeated US a 10 cm long intussusception image extending from the lower quadrant of the abdomen to the left upper side was observed. In the examination performed proximally from the ileocecal valve in the patient who was taken into surgery, no other obvious pathology was observed in the small bowel serosa.
The mucosal lesion in the sessile polyp structure was excised within the invaginated segment approximately 40 cm proximal to the ileocecal valve, located on the mesenteric side and continuing for about 10 cm, leaving intact intestinal margins. Intestinal continuity was achieved with primary anastomosis. The patient, who was fed orally on the third postoperative day, was discharged on the fifth day. Its pathology was reported as polypoid gastric heterotopia (Figure 2). The patient is followed up in the 2nd postoperative month without any complaints.
In conclusion, although HGM is asymptomatic, they can sometimes present with symptoms suggestive of acute abdomen, as in our case. Although rare, HGM should be kept in mind in such cases. This case was diagnosed as “polypoid gastric heterotype” postoperatively and presented as a rare cause of acute abdomen.
Key words: heteretopic gastric mucosa, intussusception, acute abdomen
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