GASTRIC HETEROTOPIA OF THE ILEUM WITHOUT ASSOCIATED MECKEL’S DIVERTICULUM AS A RARE CAUSE OF RECURRENT INTUSSUSCEPTION AND GI BLEEDING IN AN ADULT LUPUS PATIENT: A CASE REPORT
PAC Reyes, CB Avila, EA Gabriel, JLD Gatillo Cebu Doctors’ University Hospital
Significance: Heterotopic gastric mucosa in the ileum is a rare anomaly. From 1980 onward, there were only 19 cases with small intestinal HGM without associated morphological abnormalities that have been reported. Approximately 30 cases of HGM, located in the small bowel beyond the ligament of Treitzs and not associated with Meckel’s diverticulum, were reported. In the Philippines, there are no known published reports on incidence of this anomaly.
Clinical Presentation: A case of a 43-year old female, diagnosed with systemic lupus erythematosus since 2014, who presented with a one-month history of intermittent right upper quadrant pain. Patient had recurrent vomiting, body malaise and irritability with hypoactive bowel sounds, direct and rebound tenderness on right upper and lower quadrant areas. Worsening abdominal pain and melena with anemia were noted.
Management: CT-scan revealed ileo-colic intussusception with unidentifiable lead point. Colonoscopy revealed polypoid mass causing the intussusception at the level of the ascending colon. Reduction of intussusception was done. Previously identified lesion could no longer be located. Repeat CT-scan revealed an ileo-ileal intussusception from a previously ileo-colonic and a possible polyp as a lead point. Exploratory laparotomy with resection of ileal segment with primary anastamosis was done. Intra-operative finding revealed an intussceptum 30 cm from the ileocecal valve with a polyp as the lead point. Biopsy was done. Diagnosis was intussusception, ileo-ileal with polypoid heterotopic gastric mucosal tissue as the lead point.
Recommendation: Despite its rarity, clinicians should still consider heterotopic gastric mucosa among patients presenting with intussusception and bleeding.
Keywords: Case report, heterotopic gastric mucosa, intussusception, ileum