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Gastric Antral Diverticulum With Heterotopic Pancreas in a Teenage Patient

Lhewa, Tsering*; Zhang, Zili*; Rozelle, Christopher; Terry, Annie*

Journal of Pediatric Gastroenterology and Nutrition: November 2011 - Volume 53 - Issue 5 - p 471
doi: 10.1097/MPG.0b013e31821b0cd3
Image of the Month

*Department of Pediatrics and Doernbecher Children's Hospital

Department of Pathology, Oregon Health & Science University, Portland.

Address correspondence and reprint requests to Annie Terry, MD, CDRCP, 707 SW Gaines St, Portland, OR 97239 (e-mail:

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 14-year-old girl presented with a 2-month history of persistent epigastric pain. Both upper gastrointestinal study and esophagogastroduodenoscopy revealed a deep pouch from the gastric antrum (Fig. 1A–C). Biopsy showed eosinophilic gastritis but normal mucosa of the pouch. Given this unusual endoscopic finding and persistence of symptoms on omeprazole, the patient eventually underwent surgery and was found to have intramural diverticulum with heterotopic pancreatic parenchyma (Fig. 1D).



Although it is more common in adults and is sometimes associated with bleeding, gastric diverticulum is rare in pediatric patients (1). Congenital gastric diverticula are located commonly in the gastroesophageal junction (2), whereas acquired gastric diverticula are usually present near the antrum and are associated with peptic ulcer disease, malignancy, or prior surgery (3,4). The location of diverticulum in our case suggests an acquired etiology, and heterotopic pancreas could theoretically result in gastric wall weakness or traction diverticulum. Some authors recommend surgery to aid in diagnosis, to help alleviate symptoms that are unresponsive to medical treatment, and to prevent potential complications (ie, bleeding or perforation) (2,5). Our patient initially had decreased pain after surgery; however, her pain returned, indicating that it may be related to biopsy-proven eosinophilic gastritis.

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