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Hypergastrinemia and a duodenal ulcer caused by gastric duplication
Hideaki Tanaka1, Kouji Masumoto2, Takato Sasaki2
1Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki Prefecture, 305-8575, Japan. tanaka-h@md.tsukuba.ac.jp.
Insights
Gastric duplication, a rare cause of hypergastrinemia, was identified in a child with a duodenal ulcer. Surgical resection resolved the hypergastrinemia and ulcer, suggesting duplication as a key differential diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pathology
Background:
- Hypergastrinemia and peptic ulcers are rarely associated with enteric duplication.
- This case highlights a unique presentation in a pediatric patient.
Purpose of the Study:
- To report a rare case of hypergastrinemia and duodenal ulcer caused by gastric duplication in a child.
- To emphasize the importance of considering gastric duplication in the differential diagnosis of unexplained hypergastrinemia in pediatric patients.
Main Methods:
- Case report of a 4-year-old girl with hypergastrinemia and duodenal ulcer.
- Diagnostic workup included imaging and histological examination after surgical resection of a cystic lesion.
- Treatment involved proton pump inhibitors initially, followed by surgical intervention.
Main Results:
- A 4-year-old girl presented with hypergastrinemia and a duodenal ulcer.
- Surgical resection of a cystic lesion, confirmed as gastric duplication, led to the resolution of hypergastrinemia and ulcer.
- Histology revealed antral mucosa within the duplication, suggesting abnormal gastrin release.
Conclusions:
- Gastric duplication should be considered in the differential diagnosis of persistent hypergastrinemia in children.
- This finding expands the understanding of rare causes of pediatric hypergastrinemia and peptic ulcer disease.
Background:
Hypergastrinemia and the resultant peptic ulcer related to an enteric duplication has been quite rarely reported in the literature.
Case Presentation:
We herein report the case of a 4-year-old girl who presented with hypergastrinemia and a duodenal ulcer at 2 years of age. She had been followed up with a proton pump inhibitor, which resulted in resolution of the ulcer; however, unexplained hypergastrinemia had continued. A cystic lesion at the antrum was discovered at 4 years of age, which we suspected to be a gastric duplication. After we resected the lesion, the hypergastrinemia resolved without recurrence of the duodenal ulcer. The histology was compatible with a gastric duplication, and the lumen was lined with antral mucosa that strongly stained positive for gastrin. We presumed that the antral mucosa inside the duplication in our case had no hydrogen ion feedback inhibition of gastrin release from gastrin cells and increased release of gastrin from the mucosa inside the duplication led to the duodenal ulcer. Only two cases have been reported in the literature that had hypergastrinemia related to enteric duplication.
Conclusion:
Gastric duplication should be included in the differential diagnosis of sustained hypergastrinemia in children.
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