Heterotopic Gastric Tissue in the Scrotum

Abstract

A 2-year-old boy who underwent right inguinal herniotomy as a neonate presented with a right hydrocele. Exploration revealed a large hydrocele sac containing a creamy fluid with 2 interconnecting compartments and no patent processus vaginalis. The upper pouch was excised and the lower pouch was opened, according to Jaboulay’s operation. Histology of the sac revealed gastric heterotopia (see figure). Postoperatively a 99mtechnetium pertechnetate scan failed to demonstrate any residual gastric tissue. The patient presented 2 years later with recurrent hydrocele, which was aspirated (pH 7.34). Ten months later he is asymptomatic. DISCUSSION Heterotopia refers to the presence of tissues at sites where they are not normally found. Heterotopic gastric mucosa has been described throughout the length of the gastrointestinal tract, including the hepatobiliary system, and in the skin of the abdominal wall.’ To our knowledge we report the first case of heterotopic gastric mucosa in the scrotum. The embryonic foregut initially comprises a continuous endodermal tube encased in a thick stratum of mesoderm, which provides most of the mural and connective tissue framework of the foregut wall. In the region of the future stomach this mesodermal thickness forms a part of the primitive peritoneal cavity by clefting, cavitation and subsequent coalescence. During this process a portion of gastric mucosa, while remaining in the midline, may have been displaced into the primitive peritoneal cavity, and then may have migrated down with the testis into the scrotum. In contrast, ectopic splenic tissue has been noted only in the leR scrota1 compartment.z Our second hypothesis is that ectopic tissue developed from existing pluripotential cells in that region, which is supported by the fact that aberrant adrenal tissue has been described in the wall of the hernial sac and in the In conclusion, our case illustrates that heterotopia is not only of