Obscure GI Bleeding Secondary to Diffuse Gastric Heterotopia in the Proximal Jejunum.

Abstract

Upper gastrointestinal series with small bowel follow-through, upper endoscopy, and colonoscopy were normal. Magnetic resonance enterography showed proximal jejunal thickening. Capsule endoscopy and push enteroscopy exhibited proximal jejunal edema and ulceration; jejunal biopsies showed normal mucosa intermixed with gastric epithelium (Fig. 1). Meckel’s scan revealed ectopic gastric mucosa throughout midabdomen (Fig. 2). Laparotomy with intraoperative push enteroscopy resulted in 25 cm of jejunal resection 20 cm distal to the ligament of Treitz (Fig. 3). Pathology illustrated multifocal polypoid gastric heterotopia with reactive gastropathy and focal hemorrhage.