Ileal Heterotopic Gastric Mucosa with Small Bowel Obstruction Mimicking Inflammatory Bowel Disease: A Case Study

Je Young Cho; Ji Young Woo; Hye-Suk Hong; Ik Yang; Jin Hee Moon; Ji-Young Hwang; Han Myun Kim; Hee Young Kim; Hye Jeong Kim; Jung Won Kim

doi:10.3348/jksr.2017.77.6.412

Journal List > J Korean Soc Radiol > v.77(6) > 1087877

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Cho, Woo, Hong, Yang, Moon, Hwang, Kim, Kim, Kim, and Kim: Ileal Heterotopic Gastric Mucosa with Small Bowel Obstruction Mimicking Inflammatory Bowel Disease: A Case Study

Case Report

J Korean Soc Radiol 2017;77(6):412-415.

Published online: 19 January 2017

DOI: https://doi.org/10.3348/jksr.2017.77.6.412

Ileal Heterotopic Gastric Mucosa with Small Bowel Obstruction Mimicking Inflammatory Bowel Disease: A Case Study

Je Young Cho, MD¹, Ji Young Woo, MD^*,¹, Hye-Suk Hong, MD¹, Ik Yang, MD¹, Jin Hee Moon, MD¹, Ji-Young Hwang, MD¹, Han Myun Kim, MD¹, Hee Young Kim, MD¹, Hye Jeong Kim, MD¹, Jung Won Kim, MD²

¹Departments of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea

²Departments of Pathology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea

^*Corresponding author: Ji Young Woo, MD Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea. Tel. 82-2-829-5241 Fax. 82-2-832-1845 E-mail: baccas@hallym.or.kr

Received 24 April 201731 May 2017 Accepted 1 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastric heterotopia rarely occurs in the ileum without a Meckel’s diverticulum. We report a case of a 53-year-old man who presented with recurrent abdominal pain. The initial computed tomography (CT) scan showed circumferential wall thickening and stricture of the ileum. At the follow-up examination (8 months), previously observed circumferential wall thickening and stricture were more aggravated, causing small bowel obstruction. The patient underwent small bowel resection and the histopathol-ogy was consistent with ectopic gastric mucosa. We suggest that the rare CT findings were indicative of ileal gastric heterotopia which have never been reported. Based on these CT findings, our differential diagnosis excluded inflammatory bowel disease.

Keywords: Gastric Mucosa, Multidetector Computed Tomography, Ileum, Intestinal Obstruction, Inflammatory Bowel Disease

REFERENCES

1.Agha FP., Ghahremani GG., Tsang TK., Victor TA. Heterotopic gastric mucosa in the duodenum: radiographic findings. AJR Am J Roentgenol. 1988. 150:291–294.

2.Galligan ML., Ulich T., Lewin KJ. Heterotopic gastric mucosa in the jejunum causing intussusception. Arch Pathol Lab Med. 1983. 107:335–336.

3.Doberneck RC., Deane WM., Antoine JE. Ectopic gastric mu-cosa in the ileum: a cause of intussusception. J Pediatr Surg. 1976. 11:99–100.

4.Sagar J., Kumar V., Shah DK. Meckel's diverticulum: a system-atic review. J R Soc Med. 2006. 99:501–505.

5.Boybeyi O., Karnak I., Güçer S., Orhan D., Senocak ME. Common characteristics of jejunal heterotopic gastric tissue in children: a case report with review of the literature. J Pediatr Surg. 2008. 43:e19–e22.

6.Atik FA., Ricci M., Del Grande JC., Haddad CM. Obstruction of terminal ileum due to heterotopic gastric mucosa. Rev Assoc Med Bras (1992). 1998. 44:340–343.

7.Bertin P. Ileo-ileal intussusception over an islet of hetero-topic gastric mucosa without Meckel's diverticulum. Chir Pe-diatr. 1981. 22:7–11.

8.Smithuis RH., Vos CG. Heterotopic gastric mucosa in the du-odenal bulb: relationship to peptic ulcer. AJR Am J Roent-genol. 1989. 152:59–61.

9.Buckley JA., Fishman EK. CT evaluation of small bowel neo-plasms: spectrum of disease. Radiographics. 1998. 18:379–392.

Fig. 1.

Heterotopic gastric mucosa in ileum of 53-year-old man. A. A contrast-enhanced axial CT scan shows focal circumferential wall thickening of the ileum (length of involvement = 3.5 cm; arrows). Associ-ated luminal stricture is suggested. B, C. A contrast-enhanced axial CT scan (B) shows circumferential wall thickening of the ileum (arrows) after eight months. The luminal stricture is aggravated. A coronal CT scan (C) shows distended proximal small bowel with multiple air fluid-levels. D-F. There are two circular ulcerated lesions (arrows) in the small intestine (D). There is an ulcer (arrow) involving the submucosa and proper muscle. The submucosa and muscle layer are fibrotic and thickened (E, H& E, × 10). The gastric epithelium with surface foveolar epithelium and pyloric glands is identified next to the ulcer. Oxyntic glands, including parietal (arrowheads) and chief cells (asterisk), are also present (F, H& E, × 100, × 400). H& E = Hematoxylin and eosin stain

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