A Rare Cause of Melena and Abdominal Pain

Abstract

A 28-year-old man presented to the gastroenterology department with a 2-year history of melena and intermittent abdominal pain. Laboratory studies showed mildly decreased hemoglobin level. Esophagogastroduodenoscopy and colonoscopy were negative. Computed tomography of the abdomen showed segmental intestinal wall thickening in the mid-ileum that was suggestive of lesion (Figure A). The patient underwent transanal single-balloon enteroscopy, which revealed large mucosal folds in the mid-ileum (Figure B). A half-circumferential, shallow, and well-demarcated mucosal ulcer and short-segment stenosis were also found near the mucosal folds (Figure C, arrows indicate the half-circumferential, shallow ulcer). Biopsy of the mucosal folds identified gastric epithelial cells and fundic glands (Figure D). A diagnosis of heterotopic gastric mucosa (HGM) of the ileum was made. HGM in the small intestine is extremely rare, except for its occurrence in Meckel’s diverticulum. Intestinal mucosal ulceration with gastrointestinal bleeding is a known complication of HGM. The cause of the ulcer is due to acid pepsin secreted by the ectopic gastric mucosa. The patient was treated with oral esomeprazole. On follow-up 3 months later, the patient was doing well, with no recurrence of symptoms. To the best of our knowledge, this is the first case of so typical HGM in the small intestine to be found by enteroscopy.