A Rare Case of Symptomatic Gastric Heterotopia Causing Jejunal Intussusception

Abstract

Gastric heterotopia is the presence of gastric mucosa in an abnormal location in the gastrointestinal tract. It is rarely found beyond the ligament of Treitz; and is often benign, asymptomatic, and either congenital or acquired. There are reports of bleeding, perforation, intussusception or intestinal obstruction associated with gastric heterotopia. Adult intussusception of the small intestine is a rare, representing only 5 percent of cases of intussusception. Symptomatic gastric heterotopia is rarely reported in the small bowel beyond the ligament of Treitz, and the usual presenting age is around 14 years. We present a rare case of intussusception in a young adult secondary to jejunal gastric heterotopia. A 23 year old female presented with three months of constant epigastric pain without alleviating or exacerbating factors. She had associated bilious vomiting. Patient underwent CT imaging, that revealed dilatation of the proximal jejunum, mildly thickened jejunal wall, and areas of proximal jejunojejunal intussusception. Patient then underwent a small bowel enteroscopy, that revealed a large pedunculated multi-lobulated polyp that extended 10 cm distal into the proximal jejunum. Biopsies were taken and revealed benign gastric heterotopia with surface mucosal hyperplasia. Referral was made to surgery, and the patient underwent an exploratory laparotomy with resection of the jejunum and side to side anastomosis given her symptoms and intussusception. Post operatively and upon follow up, she was tolerating a diet, having regular bowel movements, and without abdominal pain. Adult intussusception of the small intestine is rare and in most cases caused by a structural lead point. A significant proportion of these lead points are malignant neoplasms. Gastric heterotopia presenting as a mass in the jejunum is uncommon. Per Lee SM, et al, seven cases of gastric heterotopias of the jejunum presenting as a mass have been described. Although rare, symptomatic gastric heterotopia should remain in the differential and can cause intussusception or obstruction requiring surgery for management. Lee SM, Mosenthal WT, Weismann RE, Hanover NH. Tumorous hetrotopic gastric mucosa in the small intestine. Arch Surg. 1970;100:619—622. Omotosho, Philip A., et al. Giant Polypoid Gastric Heterotopia of the Jejunum Presenting with Intermittent Intussusception. Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 17, no. 2, 2007, pp. 249—2512509_A Figure 1 No Caption available.2509_B Figure 2 No Caption available.