Rare cause of rectal bleeding

Heterotopic gastric mucosa has been identified in all levels of the gastrointestinal tract; in the rectum is an extremely rare condition, only 38 cases have been reported to date.

Patients with rectal gastric heterotopia usually present with bleeding, but other presentations and complications are possible. In the literature all but one asymptomatic case were diagnosed in infants or in young adults under 26 year age. The heterotopic tissue was frequently located in the posterolateral region of the rectum between 5 and 8cm from the anal verge. The definitive treatment was excision, either by endoscopy or surgery, although medical treatment may also provide symptom relief.

We report on a 24 year old male patient with alcohol and hard drug abuse in history, admitted with rectal bleeding, pain and tenesmus. Total colonoscopy was done, two excavated polypoid lesions with erosions were found at 4 and 7cm in opposite situation with inflammated mucosa around the lesions. The histological examination of multiple biopsies showed the presence of gastric corpus mucosa. Mucin histochemistry showed PAS-positive cells and further the cytoceratine profile was examined. The different levels of the colon revealed a normal histological picture. Because of epigastric pain, gastroscopy was done with the result of reflux oesophagitis and gastritis. Abdominal ultrasound examination was negative. As the first step of medical treatment, the patient was treated with local mesalasine and PPI, with positive results.

Summary: Heterotopic gastric mucosa in the rectum is particularly uncommon. Symptoms include proctitis and rectal bleeding. The common histology result is fundic mucosa, corpus only in 5 cases has been reported, wich histology appeared in our case, too. Endoscopic or surgical excision is the treatment of choice, although the medical therapy of our patient was also successful. The patient is still followed-up with subsequent colonoscopy, and histology planned.