Gastric heterotopia as the cause of distal small bowel obstruction: A case report.

Abstract

Background: Gastric heterotopia is defined as the presence of gastric type mucosa at a nonphysiological site. It is rare beyond the ligament of Treitz and rarely causes symptoms in adults. Aims: To highlight a rare case of symptomatic gastric heterotopia of the distal small bowel. Methods: We present a case of a 62-year-old male who presented with acute abdominal pain and distension. A CTAP showed a 14 cm dilated loop of small bowel distal to the jejunum. Appearances were initially suggestive of a small bowel volvulus or diverticulum. Results and conclusions: Following resolution of acute symptoms a diagnosis of chronic small bowel obstruction likely secondary to jejunal adhesions was made. Due to clinically stability the decision was made for an elective laparotomy, division of adhesions and small bowel resection. A 250 mm segment of small bowel was received which was dilated along its length. Significant regions of polypoid contour change were identified on the mucosal surface macroscopically. These polypoid regions corresponded to florid areas of heterotopic gastric mucosa including specialised oxyntic type glands and areas of surface foveolar epithelial differentiation. This case highlights gastric heterotopia in a rare location as the cause of acute abdominal pain and bowel obstruction.