Abstract
Heterotopic gastric mucosa is a congenital anomaly that can occur throughout the gastrointestinal tract. It has been reported in the tongue, duodenal bulb, small bowel, pancreas, gallbladder, and in the cervical esophagous ‘‘inlet patch.’’ Heterotopic gastric mucosa is extremely rare in the anorectal region [1]. We report the case of a 57-year-old man who presented with worsening anal pain and bleeding. Five years prior to current presentation, an 8-mm sessile polyp was noted in the distal rectum. Forceps biopsy of the lesion revealed heterotopic gastric mucosa. Since the patient’s symptoms were not severe, no further intervention was done. However due to the progression of his symptoms, colonoscopy was performed and revealed a flat lesion in the distal rectum (Fig. 1). Repeat biopsy confirmed benign heterotopic gastric mucosa. Because of his worsening symptoms, the patient was referred for colorectal surgical consultation. Upon further questioning, he reported a 10-year history of intermittent bright red blood per rectum, as well as post-defecation anal pain and burning. Anoscopy demonstrated a large posterior midline ulcer. Various treatment options were discussed with the patient, and he elected to proceed with surgical intervention. He underwent transanal excision of the distal rectal lesion in addition to debridement of the anal ulcer. Gross evaluation showed a 3.5 9 2.4 9 0.8 cm area of purple and pink smooth mucosa. Histopathologic assessment revealed an 8-mm focus of benign heterotopic gastric tissue. Within 2 months of the operation, the anal ulcer had healed completely and the patient’s symptoms have resolved. Heterotopic gastric mucosa has been reported throughout the gastrointestinal tract. Its presence in the anorectal region is extremely rare with only 43 cases described in the literature. Of these cases, only 11 occurred in the anal region [1]. To the best of our knowledge, this is the first case of heterotopic gastric mucosa of the distal rectum associated with an anal ulcer. Of the 39 cases reviewed by Steele [2], the presenting symptoms included painless rectal bleeding (68%), perianal ulceration (24%), anal pain (11%), abdominal pain (11%), and melena (3%). The most
Published Version
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