Neonatal necrotizing enterocolitis: a cause of gastric metaplasia in the mid-ileum

Following neonatal necrotizing enterocolitis in a premature Aboriginal baby, a stricture developed in the distal small intestine. At laparotomy a 1.0 cm stricture was found in a 25 cm thick-walled, oedematous segment of the mid-ileum. Biopsy demonstrated antropyloric-type ectopic mucosa and, therefore, the oedematous segment was removed. The resected specimen contained several distinct areas of flat antropyloric gastric mucosa as well as ileal mucosa. Although no acid-producing cells could be demonstrated, mucosal ulceration was prominent in several areas. Scanning electron microscopy demonstrated gastric pits. Immunoperoxidase technique for gastrin failed to demonstrate gastrin-containing cells. It is believed that this mucosa represents a metaplasia that has been induced in response to mucosal damage, which in turn was initiated by necrotizing enterocolitis. It is believed this would represent the first reported case.