Heterotopic gastric mucosa mimicking a Meckel’s diverticulum in a young girl ☆ James S. Davis a , Alicia C. Hirzel b , Maria M. Rodriguez b , Holly L. Neville c , Juan E. Sola c, ⁎ a Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States b Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States c Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States abstract article info Article history: Received 7 November 2014 Received in revised form 29 January 2015 Accepted 30 January 2015 Available online xxxx Key words: Heterotopic gastric mucosa Gastrointestinal bleeding Meckel’s diverticulum Heterotopic gastric mucosa (HGM) is a rare, but acknowledged source of gastrointestinal pathology in pediatric patients. Sometimes clinically confused with a Meckel’s diverticulum, HGM diagnosis is often made postopera- tively by pathology. We present a case of jejunal HGM with a positive technetium pertechnetate scan in the right lower quadrant that resembled a Meckel’s diverticulum. © 2015 Elsevier Inc. All rights reserved. Heterotopic gastric mucosa (HGM) is a rare pathology that consists of gastric secreting rests of tissue present throughout the gastrointesti- nal tract. The lesion may easily be confused with alternative pathologies more commonly associated with pediatric gastrointestinal bleeding, such as Meckel’s diverticulum, polyps, clotting disorders, arteriovenous fistulas, and inflammatory bowel disease. 1. Case report A 7-year-old girl with a past history of jejunal atresia, repaired at 3 days of age, presented with abdominal pain, bright red blood per rec- tum, and subsequent syncopal episode immediately after vomiting par- tially digested food. In the Emergency Department, the patient had coffee ground emesis and a hemoglobin of 8.8 g/dL (reference range: 11–16 g/dL), but had a normal blood pressure and heart rate. Upon ad- mission to the floor, the patient experienced a large melanotic stool, followed by hemodynamic instability with a heart rate of 125 beats/min, blood pressure of 80/50 mm Hg, and hemoglobin of 6.5 g/dL. The pa- tient was administered 430 mL of packed red blood cells, additional crystalloid resuscitation, and was transferred to the pediatric intensive care unit (PICU) for further monitoring. In the PICU, the patient had a nasogastric tube placed and was ad- ministered a continuous Octreotide drip and Ranitidine. She responded to intravenous fluid resuscitation and remained hemodynamically normal with stable hemoglobin throughout the duration of her hospital stay. Emergent upper endoscopy revealed no signs of active bleeding. A technetium-99 m pertechnetate (Tc-99 m) scan demonstrated a focus Journal of Pediatric Surgery xxx (2015) xxx–xxx ☆ Sources of funding: none. ⁎ Corresponding author at: Division of Pediatric Surgery, Department of Surgery, University of Miami Miller School of Medicine, Clinical Research Building, Suite 450K, 1120 N.W. 14th Street, Miami, Florida 33136. Tel.: +1 305 243 5072. E-mail address: jsola@med.miami.edu (J.E. Sola). Fig. 1. Technetium-99 m pertechnetate scan at forty minutes post-injection demonstrating increased uptake in the patient’s right lower quadrant. Normal uptake of the Tc-99 m nuclide is seen in the stomach and collecting in the bladder. http://dx.doi.org/10.1016/j.jpedsurg.2015.01.016 0022-3468/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Davis JS, et al, Heterotopic gastric mucosa mimicking a Meckel’s diverticulum in a young girl, J Pediatr Surg (2015), http://dx.doi.org/10.1016/j.jpedsurg.2015.01.016