53 - A Case Report of Gastric Heterotopia in the Distal Rectum

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 53
Publication Number: 53.215

Saskia D'Sa, Southern Illinois University School of Medicine, Springfield, IL, United States; Prashanth Porayette, Southern Illinois University School of Medicine, Springfield, IL, United States; Charmaine Mziray-Andrew, Southern Illinois University School of Medicine, Springfield, IL, United States

Presenting Author(s)

Saskia D'Sa, SIUSOM

Resident
Southern Illinois University School of Medicine
Springfield, Illinois, United States

Background: Heterotopic gastric mucosa (HGM) is a rare condition where gastric mucosa is present in a foreign area within the gastrointestinal or hepatobiliary tract (Dinarvand, et al 2017). It has variable prevalence in the esophagus, duodenum and in ileum as Meckle’s diverticulum (Alfrejat, et al 2017). However, it is rarely found within the rectal mucosa, let alone distal rectum.

Objective: Our 2-year-old female presented with 6-months of painless rectal bleeding and rectal prolapse that occurred with each bowel movement in the absence of either diarrhea or constipation. Her newborn screen was negative for cystic fibrosis.

Design/Methods: She underwent flexible sigmoidoscopy which revealed a non-obstructing polypoid mass 15cm x 5cm in size (Figure 1). Biopsies were sent to pathology and reported as polypoid gastric oxyntic gland heterotopia with chronic inflammation which was negative for helicobacter pylori. Repeat sigmoidoscopy with endoscopic mucosal resection (EMR) was performed which achieved partial resection of the large lesion.

Results: Post-resection, the patient was started on oral PPI and discharged with complete relief of symptoms for about 6 months before recurrence of symptoms necessitated repeat EMR. Complete resection of the GHM was achieved without complications (Figure 2). Patient was doing well without symptoms during clinic follow up.

Conclusion(s):
In pediatric patients presenting with rectal bleed or prolapse, the most common differential includes constipation. However, with our patient’s symptoms being unresponsive to Miralax and persisting rectal prolapse, it was essential to rule out other rectal pathology. Investigation can be coupled with management via endoscopy as seen in our patient along with PPI to reduce damage secondary to acid proliferation. Prompt detection and resection is essential to prevent long term complications such as ulceration, fistulas and strictures due to unrestricted acid secretion (Khan et al, 2022). In conclusion, we report a rare presentation of HGM involving the distal rectum in a young child with excellent response to surgical resection with EMR.