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• W2048006097 abstract "A 58-year-old woman with a medical history significant for diabetes mellitus, coronary artery disease, and peptic ulcer disease presented to the emergency department complaining of a 3-week history of cramping abdominal pain and rectal bleeding. The patient reported a history of a congenital rectal abnormality that required multiple corrective surgeries during childhood. Physical exam was remarkable only for mild abdominal tenderness, with no rebound or guarding. No masses were appreciated. Her laboratory studies revealed slightly elevated amylase level and were otherwise unremarkable. The patient was subsequently admitted to the gastroenterology service. Colonoscopy was performed and was remarkable only for melanosis coli. However, a retroflexed view in the rectum revealed a flat, nodular mass occupying approximately 50%–74% of the circumference. Multiple biopsies were taken. Histologic evaluation of the specimen showed fragments of colonic mucosa with focal hyperplastic changes, melanosis coli (Figure A), and separate fragments of gastric mucosa (Figure B). The heterotopic gastric tissue contained oxyntic glands (Figure C) as well as a few cells with melanotic pigments. No malignancy or Helicobacter pylori–like organisms were noted. The patient experienced no significant pain or bleeding after endoscopy. The need for surveillance colonoscopy was conveyed. Although rare, heterotopic gastric tissue is the most common large intestinal heterotopia.1Wolff M. Heterotopic gastric epithelium in the rectum: a report of three new cases with a review of 87 cases of gastric heterotopia in the alimentary canal.Am J Clin Pathol. 1971; 55: 604-606Crossref PubMed Scopus (112) Google Scholar It can occur sporadically or in conjunction with other congenital malformations. The associated congenital anomalies include rectovesical fistula, incomplete colonic rotation, rectal diverticula, and megacolon among others.2Santulli T.V. Kiesewetter W.B. Bill Jr, A.H. Anorectal anomalies: a suggested international classification.J Pediatr Surg. 1970; 5: 281-287Abstract Full Text PDF PubMed Scopus (87) Google Scholar It is believed that congenital heterotopia results from cellular entrapment during embryonic development. The displaced tissues differentiate along the lines of normal organogenesis in response to local environmental factors.3Noffsinger A. Fenoglio-Preiser C. Maru D. et al.Atlas of nontumor pathology: series 1, fascicle 5: gastrointestinal diseases.in: American Registry of Pathology Press, Washington, DC2007: 69-70Google Scholar Gastric heterotopia often remains asymptomatic and is usually an incidental finding during endoscopy or surgery for other reasons. Occasionally, bleeding can result from gastric heterotopias of the rectum. Malignant transformation has not been reported in these lesions. Gastric heterotopia might be single or multifocal lesions. Heterotopic gastric mucosa in the rectum is frequently encountered in a posterior or lateral position, 5–8 cm from the anal verge.3Noffsinger A. Fenoglio-Preiser C. Maru D. et al.Atlas of nontumor pathology: series 1, fascicle 5: gastrointestinal diseases.in: American Registry of Pathology Press, Washington, DC2007: 69-70Google Scholar The histologic appearance of heterotopic gastric mucosa is usually that of organized, normal-appearing gastric mucosa surrounded by equally normal-appearing intestinal mucosa. Heterotopic gastric mucosa does not normally require treatment unless the lesion is unusually large or causes obstruction.3Noffsinger A. Fenoglio-Preiser C. Maru D. et al.Atlas of nontumor pathology: series 1, fascicle 5: gastrointestinal diseases.in: American Registry of Pathology Press, Washington, DC2007: 69-70Google Scholar" @default.
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• W2048006097 date "2010-01-01" @default.
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• W2048006097 title "Gastric Heterotopia in the Rectum" @default.
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• W2048006097 doi "https://doi.org/10.1016/j.cgh.2009.01.020" @default.
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