Recurrent intussusception caused by giant ileal gastric heterotopia in a patient with ileocecectomy: A rare case report and literature review

Abstract

Introduction

Adult intussusception is rare, accounting for approximately 5 % of all intussusceptions and 1–5 % of bowel obstructions in adults. Gastric heterotopia of the small intestine is an uncommon lead point. This case underscores the need to consider gastric heterotopia in recurrent presentations. Recognizing this entity can facilitate prompt diagnosis, guide selection between selective reduction and en bloc resection, and expedite definitive management.

Presentation of case

A 31-year-old woman with prior ileocecectomy for intussusception presented with worsening colicky right lower-quadrant pain. CT and colonoscopy showed ileo-ileal intussusception. Controlled pneumatic reduction revealed a polypoid ileal mass; biopsies indicated gastric heterotopia. She underwent laparoscopic segmental ileal resection (10 cm) with side-to-side extracorporeal anastomosis. Histology confirmed polypoid gastric heterotopia with clear margins. Recovery was uneventful with complete symptom resolution.

Discussion

Adult intussusception is uncommon and typically arises from a pathologic lead point. Ileal gastric heterotopia is a rare benign cause with potential for recurrence. Cross-sectional imaging, often complemented by endoscopy, helps characterize the lesion and assess for ischemia. When findings indicate a benign intraluminal process without ischemia or suspected malignancy, selective reduction can aid localization and facilitate a limited, minimally invasive resection; when malignancy is suspected, en bloc resection without reduction is preferred. Definitive management is segmental resection with histopathologic confirmation.

Conclusion

Ileal gastric heterotopia is an exceptionally rare cause of recurrent adult intussusception, including after prior bowel resection. Surgical resection remains definitive and yields favorable outcomes.