Department of Pediatric Surgery, Istanbul German Hospital, Taksim, Istanbul, Turkey.
Surg Today. 2009;39(5):444-7. doi: 10.1007/s00595-008-3866-8. Epub 2009 Apr 30.
Although most cases of intussusception during childhood are caused by viral enlargement of the Peyer's patches, the remainder of the cases may be due to congenital anomalies, such as heterotopic gastric mucosa (HGM). This report presents a case of HGM in a 4-year-old boy. The patient presented with acute abdominal signs with a right lower quadrant mass. His medical history indicated three episodes of recurrent intussusceptions. The abdominal ultrasound examination detected an intussusception. A laparotomy revealed an ileocolic intussusception and reduction was accomplished. During exploration, an intraluminal mass in the ileum, which was the lead point, was discovered by palpation. An enterotomy showed a 2-cm-diameter crater-shaped mucosal thickening. An ileal resection and anastomosis was performed. The histopathological examination revealed HGM. Heterotopic gastric mucosa is supposed to be of vitellointestinal tract origin and may cause intussusception as being a lead point in the ileum. Despite its rarity, HGM should be considered in cases of recurrent intussusceptions and diagnostic studies should be performed. A laparotomy is required for the diagnosis and treatment in complicated cases. Surgical management should include reduction of the intussusception and careful manual examination of the ileum which may expose such pathology. An intestinal resection and anastomosis is sufficient to prevent complications.
虽然儿童时期大多数肠套叠是由派尔氏斑病毒肿大引起的，但其余的病例可能是由于先天性异常，如异位胃黏膜（HGM）。本报告介绍了一例 4 岁男孩的 HGM 病例。该患者表现为急性腹部体征，伴有右下象限肿块。他的病史表明曾有过三次反复发作的肠套叠。腹部超声检查发现肠套叠。剖腹探查显示回盲部肠套叠并完成复位。在探查过程中，通过触诊发现回肠腔内有一个腔内肿块，即套叠的起点。肠切开术显示 2cm 直径的火山口状黏膜增厚。进行回肠切除和吻合术。组织病理学检查显示 HGM。异位胃黏膜被认为起源于卵黄肠管，可能会引起肠套叠，成为回肠的套叠起点。尽管其罕见，但对于反复发作的肠套叠病例应考虑 HGM，并进行诊断性研究。对于复杂病例，需要剖腹探查以明确诊断和治疗。手术治疗应包括肠套叠复位和仔细手动检查回肠，这可能会暴露这种病变。肠切除和吻合术足以预防并发症。
