Gastric heterotopia has been described throughout the gastrointestinal tract, from the oral cavity to the rectum, including the liver and the gallbladder [1][2][3][4][5][6]. We report a case of peptic ulcer in heterotopic gastric mucosa of the gallbladder in a 56-year-old man submitted to laparoscopic cholecistectomy for chronic calculous cholecystitis. From the first case of gastric heterotopia of the gallbladder, reported in 1934 [7], we reviewed 49 cases, including our report. In nine cases gallstones were also found and in four cases a peptic ulcer was identified [8]. The case reported describes the first association between peptic ulcer in gastric heterotopia of the gallbladder and gallstones. The presence of HP was investigated in order to evaluate its possible role in the ethiology of the ulceration.
Case reportA 56-year-old man, with a history of Von Willebrand disease, was admitted to our hospital for a 2-year istory of episodic pain in the right quadrants of the abdomen, colicky and intermittent in character, irradiated posteriorly to the right shoulder. Physical examination revealed tenderness on palpation of the right upper quadrant of the abdomen and a positive Murphy's sign. Laboratory tests showed increased γ -glutamyltransferase (161 UI/L; normal range, 8-61 UI/L), prolonged activated protrombin time (42-60 sec; normal range, 20-36 sec), and white blood cell count in the normal range (7.63 × 10 9 /L; normal range, 4.10 × 10 9 -9.80 × 10 9 /L). Abdominal ultrasonography revealed marked parietal thickening of the gallbladder with multiple gallstones. Laparoscopic cholecystectomy was performed. The patient made an uneventful postoperative recovery and was discharged on the third postoperative day. On gross examination, the resected gallbladder contained multiple stones and an ulcerated lesion of approximately 1.5 cm in largest diameter localized in the body (Fig. 1). On hematoxylin-eosin (H&E) the lesion proved to be an area of heterotopic gastric mucosa of the fundic type (Figs. 2 and 3), without evidence of metaplastic or dysplasic changes. H&E and Giemsa stainings were carefully searched for the presence of HP, but no evidence of colonization was identified in the heterotopic mucosa.
Discussion