A Rare Cause of Rectal Bleeding!

Abstract

Purpose: The presence of gastric mucosa in the rectum is an extremely rare clinical entity with only 29 cases reported in the English literature. Heterotopia refers to the displacement of an organ or part of an organ from its normal site. Heterotopia is the result of primary displacement or a developmental abnormality where the foreign tissue is termed “heterotopia.” Gastric heterotopia in the rectum can clinically present with hematochezia, but other complications such as rectovesical and anocutaneous fistula have been reported. We report a rare case of gastric heterotopia of rectum accompanied by a brief review of the available literature. Methods: Chart review and review of literature using Medline and relevant bibliographies. Results: A 49 year old man was referred to the gastroenterology clinic with complaints of rectal bleeding since three months. Approximately 18 months ago, the patient had a normal colonoscopic exam which was performed as a work up for abnormal bowel habits. Upon presentation, a repeat colonoscopy revealed a 3 mm sessile polyp in the distal rectum. No other anorectal pathology was evident to explain the symptoms of hematochezia. The rectal polyp was resected using electrocautery snare. The pathology report of the polyp showed fragments of gastric mucosa suggestive of heterotopia. Conclusion: The common presentations of gastric heterotopia of rectum are rectal bleeding and tenesmus, but patients may present with abdominal pain or incidental mass on colonoscopy. Hematochezia usually responds to treatment with histamine 2 receptor blockers, but endoscopic or surgical excision is the treatment of choice. The literature suggests that even an incidentally discovered gastric heterotopia of rectum in an asymptomatic patient should be removed in view of possible complications such as malignant degeneration and fistula formation.[figure1][figure2]FigureFigure