Gastric heterotopia: Clinical and histological study of 12 cases

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Published Dec 20, 2011
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Vol. 89 No. (2011): Issue Dec 2011

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Ehsen Ben Brahim
Raja Jouini
Sana Aboulkacem
Farouk Jaouadi
Naceur Labbène
Raouf chérif
Youssef Helal
Sadok Sayed
Anis Ben Maamer
Aschraf Chadli-Debbiche

Abstract

Background: Gastric heterotopia is a rare congenital lesion, described everywhere in the body, but involves predominantly the digestive tract. Diagnosis is based on histologic examination and requires the presence of gastric mucosa, especially fundic. This diagnosis is usually easy, but sometimes it can be misinterpreted as gastric metapalsia . This latter is an aquired and frequent lesion of the gastrointestinal tract.
Aims: To determine the relationship between this affection and the other digestive malformations, to describe the clinical characteristics and the evolution of this lesion and to discuss the differential diagnosis particularly the gastric metaplasia.
Methods: Twelve cases of gastric heterotopia were diagnosed over a 12-year period at Habib Thameur Hospital. Clinical data was obtained and all the slides were reviewed.
Results: Nine cases were found in Meckel’s diverticulum (75%), one case in intestinal duplication, one case in the esophagus and another in the gallbladder. The mean age of patients at diagnosis was 16 years with a peak of incidence at the first decade of life. Intestinal obstruction and digestive bleeding were the most presenting features. Heterotopic gastric mucosa complicates other congenital anomalies such as common mesentery, vestigial polyp of the liver, appendiceal
agenesis and heterotopic pancreas. Differential diagnosis consists in gastric metaplasia was found extensively in a patient with Crohn’s disease associated with Meckel’s diverticulum.
Conclusion: Gastric heterotopia is frequently associated with congenital anomalies especially with Meckel’s diverticulum and digestive duplication. Diagnosis relies on histology, mainly on finding heterotopic fundic glands in normal organizational structure. Sometimes, differentiating between gastric heterotopia and gastric metaplasia requires clinical confrontation.

Keywords:

Gastric heterotopia, gastric metaplasia, Meckel's diverticulum, gall bladder, inlet path, digestive duplication, pathogenesis

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