Heterotopic gastric tissue simulating acute appendicitis

May 20, 2008

It is not uncommon to find tissue that normally lines the stomach in locations outside of the digestive tract. This "heterotopic" gastric tissue has been identified in such diverse locations as the scrotum, the gall bladder, and the spinal cord.

This case, reported by a team led by Dr. Steven Paul Schmidt, is described in the April 14, 2008 edition of the World Journal of Gastroenterology.

Typically, when this gastric tissue is located outside of the digestive system it presents no problems to the patient. This report, however, describes a patient in which the heterotopic gastric tissue became inflamed. The tissue was located in an anatomic position such that the inflammation simulated signs and symptoms of acute appendicitis.

A patient arrived in the Emergency Room with what appeared to be a relatively standard case of appendicitis. The pain had originated in the peri-umbilical area, but had localized to the right lower side of the abdomen when the patient was examined in the emergency room. The patient also had an elevated white blood cell count supporting the diagnosis of acute appendicitis.

However, when the appendix of this patient was exposed surgically it did not show any signs of inflammation. Upon further examination, Dr. Bender exposed what appeared to be an enlarged, inflamed lymph node adjacent to the appendix in connective tissue. When this lymph node was removed and examined by the pathologist it was shown convincingly to be tissue that normally lines the stomach. In addition, this gastric tissue was inflamed and showed signs of gastritis.

The patient's pain resolved as soon the heterotopic gastric tissue was removed and he has remained asymptomatic since that time.

This is an unique surgical case presentation. Although this is an extremely rare presentation, it's believed surgeons needs to be aware of the possibility of heterotopic gastric tissue simulating appendicitis when the appendix otherwise appears normal.

Source: World Journal of Gastroenterology