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Endoscopic Mucosectomy in a Child Presenting with Gastric Heterotopia of the Rectum
Joana Soares1, Carla Ferreira2, Margarida Marques3
1Serviço de Pediatria, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal.
Insights
Heterotopic gastric mucosa in the rectum is a rare cause of pediatric rectal bleeding. Endoscopic evaluation and resection can effectively treat this condition, avoiding surgery.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Gastric mucosal heterotopia can occur anywhere in the gastrointestinal tract.
- Rectal heterotopic gastric mucosa is an uncommon finding.
Purpose of the Study:
- To report a case of heterotopic gastric mucosa in a child presenting with rectal bleeding.
- To highlight the diagnostic and therapeutic role of endoscopy.
Main Methods:
- Case report of a 4-year-old boy with intermittent rectal bleeding.
- Diagnostic ileocolonoscopy revealing a rectal lesion.
- Histologic examination confirming oxyntic-type gastric mucosa.
- Treatment with proton pump inhibitors and subsequent endoscopic mucosal resection.
Main Results:
- A 4 cm flat, well-circumscribed lesion with elevated margins was identified 10 cm from the anal verge.
- Histology confirmed heterotopic gastric mucosa.
- Proton pump inhibitor therapy was ineffective.
- Endoscopic mucosal resection successfully resolved symptoms.
Conclusions:
- Heterotopic gastric mucosa is a rare cause of rectal bleeding in children.
- Endoscopic evaluation is crucial for diagnosis.
- Endoscopic mucosal resection offers a curative option, even in pediatric patients, potentially avoiding surgery.
Abstract:
Gastric mucosal heterotopia has been described in all levels of the gastrointestinal tract. Its occurrence in the rectum is uncommon. We report the case of a 4-year-old boy referred to Pediatric Gastroenterology for intermittent rectal bleeding for the past 2 years. Total ileocolonoscopy revealed a flat, well-circumscribed lesion of 4 cm, with elevated margins, localized at 10 cm from the anal verge. Histologic examination showed typical gastric mucosa of the oxyntic type. Treatment with proton pump inhibitors was started without resolution of the symptoms and, therefore, an endoscopic mucosal resection was performed. Heterotopic gastric mucosa represents a rare cause of rectal bleeding in children and endoscopic evaluation is fundamental for diagnosis. Although not usually performed in pediatric ages, endoscopic mucosectomy allows complete resolution of the problem avoiding surgery.
