Gastric heterotopia in the gallbladder

Gastric Heterotopia By D. C. Keramidas, l This

is a case report

tient

with

due

to

acute

gastric

in the Gallbladder

C. Skondras,

D. Anagnostou,

of a 7 year old pa-

noncalculous

cholecystitis

heterotopia

in

the

and

INDEX

WORDS:

gastric

heterotopia.

N. Doulas

Noncalculous

cholecystitis;

gall

bladder.

CASE A.M.,

a well developed

of the abdomen.

accompanied

Physical examination

REPORT

7 yr old male was admitted by jaundice,

disclosed tenderness

with acute pain in the right upper quadrant

nausea.

vomiting

and

in the right upper quadrant

a temperature

of

of the abdomen.

37.b,‘C

The urine

was dark. Laboratory juguted S.G.P.T.

studies: Leukocytohis

bilirubin

I.8

mg/lOO

were moderately

with 87”,, polyb. total

ml and

absence

of

increased. Serum alkaline

film Fig. 1. Preexplorotory of the showil “g dilatation hepati c ducts and flow of dye into th mesmall intestine.

serum bilirubin

urobilinogen phosphatase

from

2.2 mg/iOO

the

urine.

was 29 K.A.

units.

ml. c~,n-

S G0.T.

xnd

760

KERAMIDAS

ET Al

GASTRIC

HETEROTOPIA

Fig. 3. Microscopic appearance chief, and parietal cells ( x 160).

of the m~cosa of the ectopic gastric

tissue. There

are tnucus,

The patient was initially treated with parenteral antibiotics. in combination with antispasmodic+ and appropriate diet. He improved. but tenderness was still present on repeated examination. X-ray studies of the biliary tract revealed dilatation of the hepatic ducts. passage of dye into the small intestine, and no visuali/-atton of the gallbladder (Fig. I). At laparotomy the gallbladder was found distended with adhesions and thickening of the w..dl, particularly in the area of the neck. An intraoperative cholangiogram showed no obstruction. The cystic duct was ligated and the gallbladder removed. The excised gallbladder measured 7 x 5 cm. Bisection extending from the fundus up to the cystic duct disclosed two macroscopically different segments of mucosa. The cystic duct and the proximal area of the neck were of unusual appearance with coarse folds of whitish color. The wall of the gallbladder was increased to several times its normal thickness. No stones were found. Macroscopic examination disclosed gastric tissue in sections taken from the neck and the cysttc duct. The gastric tissue contained chief, mucus, and parietal cells and was composed of all layers including muscularis mucosae (Figs. 2. 3). The wall of the gallbladder showed typical chronic inflammation.

DISCUSSION Gastric and biliary tree primordia are closely associated in early gestational life. Heterotopia of gastric tissue in the gallbladder may result from a developmental accident or heterotopic ditferentiation. In the present case the ectopic gastric tissue in the cystic duct and neck caused some degree of obstruction leading to stasis. It seems that stasis and secretions of gastric mucoza in the gallbladder led to inflammation and adhesions between the gallbladder and the adjacent extrahepatic biliary tract. Hyperbilirubinemia was a complication of acute noncalculous cholecyctitis. This development may result from compression of the common duct by an acutely distended gallbladder from intrahepatic cholostasis or from alteration of impermeability of the gallbladder epithelium to conjugated bilirubin.’

762

KERAMIDAS

There

are ten reports

cases were accompanied occurred

in the mucosa

neck of the gallbladder

of gastric

heterotopia

by an inflammed of the gallbladder

in

the

gallbladder, in only

gallbladder.

all

or gallstones,

five cases and

or

occurring both.

its location

in

ET Al.

adults.

Heterotopic

All tissue

was at or near the

in nine cases.’ REFERENCES

I.

Dumont

bilirubinemia Obstet

142855,

AE:

Signiticance

in acute cholecystitis. 1976

of

hyper-

Surg Gynec

2. Curtis

LE,

Sheahan

sues in the gallbladder.

DG: Arch

Heterotopic

tis-

Path 88:677.

I969