|Year : 2015 | Volume
| Issue : 1 | Page : 45-46
Ectopic cutaneous umbilical gastric mucosa
Kamal Nain Rattan1, Pallavi Sonika2, Shubha Lal3, Ananta Rattan1
1 Department of Paediatric Surgery, PGIMS, Rohtak, Haryana, India
2 Department of Paediatrics, PGIMS, Rohtak, Haryana, India
3 Department of Pathology, PGIMS, Rohtak, Haryana, India
|Date of Web Publication||17-Jun-2015|
Dr. Shubha Lal
A-19, Aakash Ganga Apartments, Plot No. 17, Sector 6, Dwarka, New Delhi - 110 075
Source of Support: None, Conflict of Interest: None
A 2-year-old male child presented with a complaint of bleeding from umbilicus every 15 days since birth on and off. Child was managed successfully by exploratory laparotomy and local umbilectomy. Histopathology showed gastric mucosa from the excised tissue.
Keywords: Gastric, mucosa, umbilicus
|How to cite this article:|
Rattan KN, Sonika P, Lal S, Rattan A. Ectopic cutaneous umbilical gastric mucosa. J Exp Clin Anat 2015;14:45-6
| Introduction|| |
Ectopic tissue refers to the finding of normal tissue in foreign sites, entirely separate from the main organ. Ectopic gastric mucosa has been observed throughout the alimentary tract, everywhere from the oral cavity to the rectum (Langkemper et al., 1980). They have also been seen in the intestinal duplication, Meckel's diverticulum, gallbladder or cystic duct and omphalomesenteric duct (Gorlin et al., 1964; Martinez-Urrutia et al., 1990; Willis 1968). However, occurrence in the umbilicus is extremely rare and after extensive search of literature we found only three cases of ectopic gastric mucosa in the umbilicus (Heo and Jeong 2010; Sharma et al., 2013; Shim and Kim 1992). The first case was reported by Shim et al. in 1992 where they had found heteropic gastric mucosa and pancreatic tissue and occurrence of isolated gastric musosa was reported by Heo et al. in 2010. We are reporting the case of ectopic gastric mucosa in the umbilicus due to rarity.
| Case Report|| |
A 2-year-old male child, presented to the outpatient department of our hospital with the complaint of bleeding from umbilicus every 15 days since birth lasting 2-3 days. The child was born through normal vaginal delivery following an uneventful gestational period and had no other complaints like vomiting, constipation, etc. Coagulation profile and platelet counts were normal. Factor 8 and 9 levels were also normal and had no history of bleeding from any other site. There is no history of bleeding diathesis in the family. However, child was anemic and was transfused blood but there was no hepatospleenomegaly.
Physical examination showed a reddish papule with skin rugae. Ultrasound abdomen was normal and revealed no omphalomesenteric duct remnant. The child underwent subumbilical laparotomy. No Meckel's diverticulum or any omphalomesenteric duct remnant was observed. So, local umbilectomy was done, and abdomen was closed in layers. Histopathological examination of the excised tissue revealed the lining of the gastric mucosa. No neoplastic changes were detected. The patient recovered completely after the surgery [Figure 1] and [Figure 2].
|Figure 1: Lining of gastric mucosa surrounded by fibrous tissue and muscle in the excised tissue (H and E, ×40)|
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| Discussion|| |
Umbilical nodules and granulomas are common in infants and young children. Mostly these nodules vary from solitary lesions to severe congenital anomalies of omphalomesenteric duct. The following theory has been postulated for ectopic tissue - during embryogenesis, the mid gut rotates 90° counter-clockwise within the umbilical cord, around the axis of the superior mesenteric artery, elongating to form the jejunum and ileum. By 10 th week of embryogenesis, the lumen of omphalomesenteric duct closes and midgut returns to the abdominal cavity. It is at this point of time, when gastric mucosa cells could be seeded in the umbilical area (Bauer and Retik 1978). The occurrence of gastric mucosa in umbilicus is very unusual. The main presentation in these cases may be serous discharge, excoriation of skin and bleeding. Ultrasonography is done to rule to rule out any omphalomesenteric remnant. Treatment is complete excision and diagnosis is confirmed by histopathological examination.
| References|| |
Bauer S.B., Retik A.B. (1978). Urachal anomalies and related umbilical disorders. Urol Clin North Am 5 (1):195-211.
Gorlin R.J., Kalnins V., Izant R.J. (1964). Occurrence of heterotopic gastric mucosa in the tongue. J Pediatr 64:604-6.
Heo Y.S., Jeong Y. (2010). Heterotopic gastric mucosa in the umbilicus. Ann Dermatol 22 (2):223-5.
Langkemper R., Hoek A.C., Dekker W. (1980). Elevated lesions in the duodenal bulb caused by heterotopic gastric mucosa. Radiology 137 (3):621-4.
Martinez-Urrutia M.J., Vasques E.J., Larrauri J. (1990). Gastric heterotropy of the biliary tract. J Pediatr Surg 25 (3):356-7.
Sharma S., Maheshwari U., Bansal N. (2013). Ectopic pancreatic, gastric and small intestine tissue in an umbilical polyp, causing persistent umbilical discharge in a 2 year old child - A rare case report. 2 (5):447-9.
Shim Y.T., Kim S.Y. (1992). Heterotopic gastric mucosa and pancreatic tissue in the skin of the abdominal wall. J Pediatr Surg 27 (12):1539-40.
Willis R.A. (1968). Some unusual developmental heterotopias. Br Med J 3 (5613):267-72.
[Figure 1], [Figure 2]