Release of the jejunal-jejunal intussusception was successful with a primary side-to-side bowel anastomosis. Histological examination of the polyploid lesion showed extensive gastric tissue resembling the body of the stomach, characterized by the gastric mucosal epithelium and abundance of parietal and chief cells without atypia or malignancy (Figure 3). Some areas showed strands of smooth muscle within the fibrovascular stalk and the mucosa. Because of the presence of smooth muscle within the mucosa, Peutz-Jeghers polyp was considered in the differential diagnosis. However, a giant polypoid gastric heterotopia was considered more probable because of the presence of extensive gastric tissue within the jejunum.
To our knowledge, our case represents the largest pedunculated mass of HGM, also known as an ectopic stomach, reported in the literature. When gastric glands are found in an organ other than the stomach, the term aberrant gastric gland is used.9 This anomaly is further divided into 2 categories: gastric heterotopia and gastric metaplasia. Congenital (heterotopic) infers abnormal embryological development, whereas acquired (metaplastic) infers acquisition secondary to inflammation or disease. The development of HGM in our case most likely favors a congenital error in differentiation, given the morphological similarity between the jejunal polypoid lesion and the gastric epithelium and exocrine secretory cells of the stomach. Despite the clinical diagnosis of peptic ulcer disease, metaplastic change because of hyperacidity was not apparent, given the abundance of parietal and chief cells without atypia or malignancy.
In conclusion, definitive diagnosis of HGM requires a detailed histopathological examination.13 Careful consideration and endoscopic exploration are recommended for patients presenting with symptoms of intestinal obstruction, bleeding, perforation, ulceration, vomiting, intussusception, and chronic abdominal pain. We describe a case in which the above symptoms resulted in the discovery of a giant pedunculated lesion in the jejunum causing small bowel intussusception.
Author contributions: S. Hazan wrote the manuscript and is the article guarantor.
Financial disclosure: S. Hazan has a pecuniary interest in Ventura Clinical Trials and in ProgenaBiome.
Informed consent was obtained for this case report.
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