Simultaneous heterotopia of the gastric mucosa and pancreatic tissue leads to perforation of the small intestine: case report and literature review.

BACKGROUND

Heterotopic gastric mucosa (HGM) and heterotopic pancreas (HP) are two relatively rare congenital disorders that typically occur independently in the esophagus and stomach and seldom leading have been to severe symptoms. In this study, we describe the simultaneous presence of these two ectopic tissues in the small intestine, which resulted in gastrointestinal perforation. This rare case underscores the significant pathogenic potential when HGM and HP coexist in an uncommon anatomical location.

CASE DESCRIPTION: A 16-year-old female underwent exploratory laparotomy due to suspicion of gastrointestinal perforation. During the surgical procedure, a perforation of the small intestine was identified, and a suspicious submucosal nodule was observed near the site of perforation. A partial small bowel resection with end-to-end anastomosis was subsequently performed. Postoperative pathological examination revealed that the nodule contained gastric fundic mucosa and pancreatic acinar cells. The patient's postoperative recovery was uneventful, with resolution of abdominal pain and successful resumption of a normal diet. The patient was discharged on the 15th postoperative day.

CONCLUSIONS

We report a rare and instructive case of concurrent HGM and HP in the small intestine causing life-threatening perforation. Our analysis, supplemented by a review of the literature, indicates that the coexistence of these two ectopic tissues significantly increases the risk of severe complications compared to their isolated occurrence. This finding underscores the necessity for a heightened index of clinical suspicion for dual ectopia in patients with unexplained abdominal symptoms. Therefore, we propose that upon early identification of such dual ectopia, even if asymptomatic, a more proactive management strategy should be considered to prevent catastrophic complications like perforation.