Ectopic “Ectopic” Gastric Mucosa

TL;DR

This paper presents a rare case of ectopic gastric mucosa in an unusual location, highlighting the importance of recognizing atypical imaging findings for timely diagnosis.

Contribution

The paper reports a unique case of ectopic gastric mucosa in the mid ileum, not previously documented in the literature.

Findings

Tc-99 scintigraphy showed ectopic gastric mucosa in the upper mid abdomen, confirmed surgically to be in the mid ileum.

The case is the first reported instance of ectopic Meckel’s diverticulum in the literature.

Atypical imaging presentations of ectopic gastric mucosa can aid radiologists in timely diagnosis.

Abstract

Meckel’s diverticulum is a developmental GI anomaly. It is a remnant of the omphalomesenteric duct (vitelline duct) and the most common congenital anomaly found in the small intestine. It contains ectopic/heterotopic gastric mucosa in half of the cases. Imaging investigations for diagnosing Meckel’s diverticulum may include a plain radiography; however, this has a very limited diagnostic value. A blind-ending fluid-filled structure can sometimes be seen with sonography, but again, this technique’s diagnostic value is limited due to multiple factors. A CT scan may be helpful in localizing the bleeding diverticulum, which can be better visualized with CT enterography. Diverticula containing gastric mucosa can be diagnosed with a higher sensitivity with Tc-99 scintigraphy. The typical location of Meckel’s diverticulum is within two feet of the ileocecal valve; thus, ectopic gastric mucosal uptake is typically seen in the lower right quadrant in scintigraphy. We present a rare case of Tc-99 pertechnetate scintigraphy showing ectopic gastric mucosa in the upper mid abdomen, which was surgically proven to be at the mid ileum. To our knowledge, there is no ectopic Meckel’s diverticulum case published in the literature. Familiarity with this atypical imaging presentation of relatively common ectopic gastric mucosa may help the radiologists in the timely diagnosis and management of the patient.

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