Metaplastic Gastric Mucosa Mimicking a Gastric Heterotropia in a Small Intestine of Patient Presenting with Recurrent Subocclusive Episodes

Case Report

Austin J Cancer Clin Res 2015;2(4): 1040.

Metaplastic Gastric Mucosa Mimicking a Gastric Heterotropia in a Small Intestine of Patient Presenting with Recurrent Subocclusive Episodes

Gupta P¹, Shabnam N¹, Tiwari N¹, Mahendru V² and Srivastava AN¹*

¹Department of Pathology, Era’s Lucknow Medical College & Hospital, India

²Department of Surgery, Era’s Lucknow Medical College & Hospital, India

*Corresponding author: Srivastava AN, Department of Pathology, Era’s Lucknow Medical College & Hospital, Lucknow, India.

Received: June 15, 2015; Accepted: June 30, 2015; Published: July 04, 2015


Heterotropia means presence of normal tissue at an abnormal position. Abnormal embryological development presents as congenitally present heterotrophic tissue. Gastric heterotropia are mostly seen in duodenum but very rarely in small intestine [1]. Isolated cases of heterotopic gastric mucosa have been reported at all levels of the alimentary tract from the oesophagus to the rectum. Gastric heterotropias commonly occur in duodenum, esophagus and rectum but presence of heterotrophic tissue rest in ileum and jejunum is a very rare finding. Metaplasia is a change in one type of fully developed tissue to another differentiated tissue usually due to sustained inflammation and its complication [2]. It may either be acquired metaplasia as in Barrett’s esophagus or a true gastric heterotropia of congenital origin as in Meckel’s Diverticulum. The biggest diagnostic confusion is of a simple true congenital gastric heterotropia being misdiagnosed as a gastric metaplasia [3].

A patient with heterotropias might present with a spectrum of symptoms, from asymptomatic to ulcers in to intestinal obstructions. Intussusception, perforation, bleeding and pain are common complications with heterotropias. Generally gastric heterotropias are flat lesions with mild plate like elevations that are missed radiologically [4]. We report a case of a 40 year old male who presented with subacute intestinal obstruction. He was diagnosed as a case of focal ileal gastric heterotropia as a cause of this partial obstruction.

Case Presentation

A 40 yr old male presented to the emergency with acute abdominal pain and inability to pass stool or flatus. On examination his abdomen was soft on palpation and rapid bowel sounds were heard on auscultation. His PR examination showed empty rectum. His vitals and other systems were within normal limits. The patient was taken up for emergency exploratory laparotomy under GA. On opening the bowel, strictures and adhesion in a part of small intestine was seen and a segment was sent for histopathology. All his other blood investigations were within normal limits. Unfortunately no USG findings were available as this was a case of emergency laparotomy. Grossly a segment of small intestine was received (Figure 1). Cut surface shows focal sharply marginated slightly elevated area with haphazard convoluted thickened mucosal rugosities different from surrounding intestinal mucosa which shows transverse well oriented grayish white mucosal rugosities. Lumen proximal to this was dilated with partially atrophied mucosa. Histopathologically, section from the lumen showed scattered mucinous glands both above and below the muscularis mucosa surrounded by irregularly oriented smooth muscle cells. Overlying mucosa showed partially flattened villi lined by columnar cells with scattered goblet cells (Figures 2a,2b). Dense chronic inflammatory infiltrate was seen extending up the muscularis layer. Focal areas showed dilated lymphatics and congested blood vessels (Figure 3). These glands below the muscularis were PAS positive and Alcian blue negative, which confirmed the neutral mucin in these glands suggesting a foveolar epithelium of gastric mucosa (Figures 2c,2d). Overlying small intestinal mucosa showed goblet cells with Alcian blue positivity (Figure 2c). No gastric glands or chief cells or parietal cells were seen. A diagnosis of Ectopic gastric foveolar mucosa was made as a cause of stricture with intestinal obstruction. Therefore it was concluded that this gastric mucosa was of metaplastic etiology.