- Heterotopia of the gastric mucosa in the rectum: a clinical case report
Heterotopia of the gastric mucosa in the rectum: a clinical case report
Modern Pediatrics. Ukraine. (2023). 2(130): 117-120. doi 10.15574/SP.2023.130.117
Kosmynina N. S.1, Luchak M. V.2
1Danylo Halytsky Lviv National Medical University, Ukraine
2Lviv Regional Children’s Clinical Hospital «OHMATDYT», Ukraine
For citation: Kosmynina NS, Luchak MV. (2023). Heterotopia of the gastric mucosa in the rectum: a clinical case report. Modern Pediatrics. Ukraine. 2(130): 117-120. doi 10.15574/SP.2023.130.117.
Article received: Jan 04, 2023. Accepted for publication: Mar 13, 2023.
Heterotopic gastric mucosa is rare in the paediatric population, but it can pose a diagnostic challenge. This pathology can occur in any part of the digestive tract, from the oropharynx to the anorectal area. Most cases are observed in the esophagus, duodenum and hepatobiliary system, but the presence of this tissue in the rectum is extremely rare.
Purpose – conduct a clinical description of a rare pathology in children in order to pay the doctors` attention to the need for comprehensive diagnosis of patients with hematochezia.
Clinical case. We present a clinical case of a child with heterotopia of the gastric mucosa into the rectum. Symptoms included hematochezia and anal pain during the act of defecation, general weakness, and decreased appetite. These manifestations were observed for two years with periods of exacerbations and remissions on the background of conservative treatment. The final diagnosis was made on the basis of a biopsy of nodular formations of the rectum, detected by colonoscopy.
Conclusions. Given the negative impact of the disease manifestations on the patient's quality of life and the potential risk of malignant transformation, the possibility of heterotopic gastric mucosa in the rectum with indeterminate bleeding from the lower gastrointestinal tract should be considered and a complete examination, including biopsy, should be performed. Once the diagnosis is confirmed, radical surgical removal is recommended. Initial conservative treatment with proton pump inhibitors provides only short-term relief and is accompanied by periods of exacerbation and remission. The final treatment is always surgical or endoscopic excision of the heterotopic mucosa.
The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: pediatrics, heterotopia, stomach, rectum.
REFERENCES
1. Antemie G, Apostu A, Rogojan L at al. (2019). Ulcerative colitis associated with gastric heterotopia in the rectum: a case report. J Gastrointestin Liver Dis. 28 (1): 117-120. https://doi.org/10.15403/jgld.2014.1121.281.ulc
2. Covington D, Zong Y, Talat A at al. (2022). Mass-Forming Gastric Heterotopia of the rectum: A Series of 3 Cases from a Single Tertiary Health Center. Am J Case Rep. 23: 936631. https://doi.org/10.12659/AJCR.936631; PMid:35881563 PMCid:PMC9339256
3. Dinarvand P, Vareedayah A, Phillips N at al. (2017). Gastric heterotopia in rectum: A literature review and its diagnostic pitfall. SAGE Open Medical Case Reports. 5: 1-5. https://doi.org/10.1177/2050313X17693968; PMid:28321304 PMCid:PMC5347492
4. Fernandes S, Safavi A, Cloutier B at al. (2020). Heterotopic gastric mucosa in the rectum. Journal of Pediatric Surgery Case Reports. 63: 1-2. https://doi.org/10.1016/j.epsc.2020.101673
5. Galassi L, Guerrazzi G, Romeo B. (2021). Gastric Mucosa Heterotopia in Distal Rectum: a Case Report and Narrative Literature Review. Comprehensive Clinical Medicine. 3: 1469-1476. https://doi.org/10.1007/s42399-021-00897-1
6. Hintz G, Zou V, Baird R. (2019). Sclerotherapy for rectal prolapse in children: a systematic review and meta-analysis. J Pediatr Surg. 54 (5): 1083-1088. https://doi.org/10.1016/j.jpedsurg.2019.01.033; PMid:30782440
7. Iacopini F, Gotoda T. (2016). Heterotopic gastric mucosa in the anus and rectum: first case report of endoscopic submucosal dissection and systematic review. Gastroenterol Rep. 4 (3): 196-205. https://doi.org/10.1093/gastro/gow006; PMid:27103738 PMCid:PMC4976682
8. Kim H, Kim J. (2012). Heterotopic gastric mucosa with focal intestinal metaplasia and squamous epithelium in rectum. Dig Endosc. 24: 46-48. https://doi.org/10.1111/j.1443-1661.2011.01160.x; PMid:22211412
9. Mannan A, Vieth M, Khararjian A. (2018). The outlet patch: Gastric heterotopia of the colorectum and anus. Histopathology. 73 (2): 220-229. https://doi.org/10.1111/his.13632; PMid:29667709