Ectopic gastric mucosa

May contain rests of ectopic gastric mucosa and present with intestinal bleeding... 

To diagnose ectopic gastric mucosa (Meckel s diverticulum)... 

Diagnosis of ectopic gastric mucosa using 185 MBq of intravenously injected Tc-per-technetate corresponds to an effective dose of approximately 2.4 mSv. 

Kumar et al. (2005) described a series of 11 (male) children in which the diagnosis of ectopic gastric mucosa could be made by the use of 99Tcm-... 

Meckel diverticulum is the most common congenital anomaly of the GI tract and is the most common site for ectopic gastric mucosa. GI duplications (non-communicating or more rarely communicating) are less common and 20%-30% of these will contain ectopic gastric mucosa. It is also more commonly seen in tubular duplications (in contrast to cystic). 

Patients with functioning ectopic gastric mucosa will present with pain, bleeding and perforation. However, patients with intrathoracic foregut duplication cysts, mainly younger patients, will present with respiratory distress caused by compression of the airway. 

In half of the patients with complaints dinical signs manifest in the first 2 years of life. Ulceration occurs only in those that contain ectopic gastric mucosa and thus is rare, but can cause occult fecal blood or frank blood in stool and anemia. Adhesions and formation of scar tissue can lead to obstructive ileus. The diverticulum can act as a lead point for ileocolic or ileoileal intussusception. 

Fig. 4.2. Ectopic gastric mucosa. This is demonstrated as a mucosal irregularity on the right lateral aspect of the upper oesophagus (arrows) this was only confirmed on a repeat endoscopy...

The patients were elderly, and many had no symptoms referable to the esophagus until their admission to the hospital. Death usually occurred from perforation into a large vessel, the pericardium, the mediastinum, or the pleural cavity, although some died of pneumonia. Of interest was the fact that few exhibited symptoms of esophageal obstruction. Tileston further reported that the histology of such ulcers was identical to that of chronic gastric ulcer, and that the adjacent mucosa was gastric in type. He assumed it to be ectopic, because it lined the lower part of the gut in the mediastinum. 

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