Worsening Ileal Stenosis Caused by Multiple Ectopic Gastric Mucosa Lesions in an Elderly Patient: A Novel Case with a Long Observation Period

Abstract

INTRODUCTION: Ectopic gastric mucosa (EGM) is a hyperplastic primitive gut epithelium found in tissues other than the stomach. EGM in the small intestine, distal to the ligament of Treitz (EGMdT), is uncommon. EGMdT without congenital anomalies has rarely been reported. Most reported cases are diagnosed in youth, with a single lesion and urgent symptoms requiring emergency surgery. Herein, we report a unique case of multiple EGMdTs without congenital anomalies that caused progressive ileal stenosis in an elderly patient with an observation period of 11 years.

CASE PRESENTATION: The patient was a 77-year-old man. On a medical exam 11 years before arrival at our hospital, the patient was diagnosed with EGMdT in the terminal ileum without stenosis. Five years after the initial diagnosis of EGMdT, the patient experienced his first episode of bowel obstruction, which was treated conservatively. The patient experienced three episodes of bowel obstruction, all of which were treated conservatively. The patient was then referred to our hospital for further examination and treatment. Colonoscopy at our hospital showed an EGMdT that protruded from the Bauhin’s valve. Double-balloon colonoscopy revealed a lymph follicle-like elevation 20 cm from the Bauhin’s valve with obvious stenosis. No malignancies were found on lesion biopsy. The fluoroscopic gastrointestinal series showed five lesions on the oral side of the Bauhin’s valve. Based on these findings, the patient’s symptoms were considered as the outcome of ileal stenosis caused by multiple EGMdTs; therefore, surgical resection was recommended. Laparoscopic resection of the lesion was performed. Intraoperative findings were not suspicious of malignancy. There were five erosions in the resected specimen, and all lesions were diagnosed as EGMdTs without malignancies. The patient was discharged on the 7th postoperative day without any complications. The patient had no recurrent symptoms after discharge.

CONCLUSIONS: Based on the present case, we recommend that clinicians consider surgical resection for symptomatic EGMdT, even without malignancy, and screen for multiple lesions to avoid residual EGMdT.