Bile duct obstruction secondary to heterotopic gastric mucosa

• Published in: Journal of pediatric surgery case reports 2020-10, Vol.61, p.101578, Article 101578
• Main Authors: Linden, Allison F., Raiji, Manish T., Azzam, Ruba, Alpert, Lindsay, Deshpande, Prashant, Emolo, Jared, Deshpande, Abhishek, Slidell, Mark B.
• Format: Article
• Language: English
• Subjects: Bile duct; Heterotopic gastric mucosa; Pyloric metaplasia
• ISSN: 2213-5766; 2213-5766
• DOI: 10.1016/j.epsc.2020.101578

We present the first reported case of heterotopic gastric mucosa (HGM) with pyloric type metaplasia obstructing the bile duct, with a literature review of bile duct obstruction from other types of HGM in children and adults. A 10-year old boy presented with severe, episodic, post-prandial, epigastric pain. An extensive work-up found a partially obstructing lesion of the common bile duct adjacent to the cystic duct. He underwent surgical resection of the lesion with restoration of the biliary drainage via choledocho-duodenostomy. Pathology revealed heterotopic gastric mucosa with pyloric metaplasia. Recovery was uneventful and he remains symptom-free 36 months later. Obstructing lesions of the biliary tree are exceedingly rare in children. In contrast with adults, there is minimal concern that such a lesion represents a malignancy. This may lead to prolonged diagnostic work-up as opposed to early surgical exploration. While it can be difficult to differentiate between benign and high-risk bile duct lesions in adults, malignant transformation of HGM of the bile duct has only been reported in an adult. In every pediatric and adult case reviewed, surgical exploration was required to establish the diagnosis. Our patient's pathology revealed pyloric type metaplasia as a component of HGM. This is the first report of pyloric type metaplasia in the literature. Previously reports have only shown HGM of fundic origin. We advocate early resection of these lesions for both diagnostic purposes, and due to the potential for malignant transformation.