Gastric Heterotopia in the Rectum

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.

• 
  • View Large Image
  • Download to PowerPoint