Life-threatening gastrointestinal bleeding caused by jejunal heterotopic gastric mucosa in an adult dog: a rare case report

Abstract

Background: Heterotopic gastric mucosa has been scarcely reported in the veterinary literature. Its presence can be asymptomatic or associated with various clinical signs ranging from apathy, vomiting, to abdominal pain. This report illustrates the presence of heterotopic gastric mucosa in the jejunum of an adult dog. It is the first to describe severe anemia, requiring acute blood transfusion, following intestinal hemorrhage caused by heterotopic gastric mucosa.

Case presentation: A twelve-year-old, intact male Maltese dog was presented with a history of apathy, vomiting and anemia. The dog was on a strict diet for recurrent diarrhea, food intolerance and skin allergy. Clinical examination revealed severe anemic mucous membranes and painful abdominal palpation. Blood examination confirmed severe regenerative anemia. Ultrasonography showed an intestinal neoplasm, gall bladder sludge and non-homogeneous liver parenchyma. Three-view thoracic radiographs failed to show any metastatic lesions or enlarged lymph nodes. After initial stabilization and blood transfusion, a midline exploratory laparotomy was performed. Three different masses were found in the jejunum. Resection and anastomosis of approximately 40 cm of jejunum was performed, followed by liver and lymph node biopsy and placement of an esophagostomy tube. Two days after surgery the dog started to clinically improve and was discharged from the hospital on the sixth day after surgery. Histopathology revealed the intestinal masses to be heterotopic gastric mucosa associated with intramural cystic distensions, multifocal ulceration and bleeding into the intestinal lumen. Two years after surgery, the dog did not have a recurrence of anemia or gastrointestinal signs.

Conclusions: This case demonstrates that heterotopic gastric mucosa can be considered one of the differential diagnoses in case of severe anemia due to gastrointestinal hemorrhage and suspected intestinal tumors. Although in most described cases in literature the finding seems to be incidental on necropsy, our report shows that heterotopic gastric mucosa can be the etiology of life-threatening signs. In addition, because no recurrent diarrhea episodes occurred after surgical resection of the ectopic tissue, it is likely that the heterotopic gastric mucosa was the cause of the food intolerance signs in this dog.

Keywords: Anemia; Case report; Differential diagnosis; Ectopic tissue; Heterotopic gastric mucosa; Intestinal bleeding; Intestinal mass.

Fig. 1

Formalin-fixed and trimmed intestinal specimen. Multiple cysts (x) expand the intestinal wall. To the right the intestinal lumen is seen (∞)

Fig. 2

Histological cross-section of intestinal mass. The normal jejunal mucosa on the right side (o) encircles the intestinal lumen (∞) and is partly displaced by heterotopic gastric fundic mucosa (*) extending through the submucosa into the muscularis. The cystic spaces (x) show focal ulceration (arrowhead) with extravasation of inflammatory cells and erythrocytes. Hematoxylin–Eosin, bar = 1 mm

Fig. 3

Area of heterotopic gastric mucosa showing unorganized arrangement of the different epithelial cell types and ulceration accompanied by acute bleeding into the intestinal lumen, hyperemia and neutrophilic and lymphoplasmacellular infiltration. Hematoxylin–Eosin, bar = 80 µm