[Histopathological variations in the vitelline duct in heterotopic gastric mucosa with special reference to inflammatory changes. (Study of resected specimens from 1956-1995)].

Cases of resected vitellointestinal duct remnants (including Meckel's diverticula, fistulae and a cyst) diagnosed at the Histopathology Department of our hospital between 1956 and 1995 were reviewed for the presence of heterotopic gastric mucosa. The review of the files included the whole archives of the Bács-Kiskun County Hospital. The files contained 166 records of vitellointestinal duct remnant; of these 151 were evaluated and 28 were shown to involve ectopic gastric mucosa. Seven of these latter had no assessable surface mucosa, and therefore only 21 specimens were evaluated for "gastric" histopathologic changes. "Gastritis" was seen in all cases, however the pattern that predominated was that of chemical gastritis, which has not yet been documented at this location. It was present in 57% of cases and could also account for some symptoms leading to the removal of appendices with no histopathologic signs of inflammation. Chronic and chronic active gastritis-like inflammation were also demonstrated in some cases. Those with moderate or severe activity were associated with peptic ulceration or macroerosions. No Helicobacter pylori like organisms were detected with the modified Giemsa stain and haematoxylin & eosin stain. No conclusions could be drawn regarding the role nonsteroidal anti-inflammatory drugs played in erosive gastritis-like diverticulitis because of the lack of information on the use of such agents; however erosions were rare (14%). The fact that the proportion of ectopic gastric mucosa found in several studies (including this one) is about half that suggested by textbooks indicates a need for a more detailed work up of resected Meckel's diverticulum and a search for all kinds of gastric pathology if gastric heterotopia is present. The identification of chemical gastritis like inflammation, which is often viewed and documented as normal mucosa is also important in this process.