Clin Endosc.  2017 Nov;50(6):605-608. 10.5946/ce.2017.026.

Endoscopic Treatment of Jejunal Heterotopic Gastric Mucosa that Caused Recurrent Intussusception

• Ahn KR
• Koo JS
• Kim HI
• Kim JH
• Lee JH
• Kim SY
• Jung SW
• Lee SW

• KMID: 2398314
• DOI: http://doi.org/10.5946/ce.2017.026

Abstract

Heterotopic gastric mucosa (HGM) is a rare anomaly in the small bowel and may be the cause of intussusception when it gets a lead point in the jejunum. All cases of intussusception due to intestinal HGM have been treated with surgical resection. A 5-year-old girl presented with chief complaints of vomiting and abdominal pain for 2 weeks. A computed tomography scan of the abdomen showed intussusception at the proximal jejunal loops. Three air reductions and one saline reduction were attempted without success. She continued to be symptomatic, and endoscopic evaluation was performed. Enteroscopy revealed some variable-sized polypoid mucosal lesions with erosions on the proximal jejunum. Endoscopic mucosal resection was performed using a snare. The resected tissues histologically showed a hyperplastic polyp arising from the HGM. Her symptoms did not recur within 1 year after the treatment. Our case showed that enteroscopy could be useful for the diagnosis and management of jejunal intussusception caused by HGM.

Keyword

Heterotopic gastric mucosa; Recurrent jejunal intussusception; Endoscopic mucosal resection; Jejunal polyp

MeSH Terms

Abdomen
Abdominal Pain
Child, Preschool
Diagnosis
Female
Gastric Mucosa*
Humans
Intussusception*
Jejunum
Polyps
SNARE Proteins
Vomiting
SNARE Proteins

Figure

• 

  Fig. 1. Abdominal ultrasonography shows an intussuscepted inner segment and edematous outer bowel in the left upper quadrant.

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  Fig. 2. Abdominal computed tomography further localizes the intussusception in the proximal jejunal loops (arrow).

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  Fig. 3. Endoscopic images of the polypoid lesions in the proximal jejunum. (A) The largest polyp almost completely fills the jejunal lumen. (B) Variable-sized polypoid mucosal lesions with erosions.

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  Fig. 4. Histopathologic evaluation shows a foveolar epithelium and cystic change in the hyperplastic polyps arising from the gastric mucosa (Hematoxylin & eosin staining, ×20).

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