Abstract

Heterotopic gastric mucosa in small intestine, other than in Meckel's diverticulum or other congenital anomalous conditions, is exceedingly rare. The origin of ectopic gastric mucosa in small intestine is open to conjecture. Two concepts have been presented in the literature that these lesions represent. Congenital anomalies or that they arise by metaplasia from existing or neoplastic intestinal epithelium. We experienced a case of aberrant pyloric glands and gastric mucosa in tuberculous enteritis accompanying with multiple stensis of small intestine. A 23 year old female who admitted to Dept. of internal medicine, because of generalized abdominal pain and tenderness for 2 months. Grossly, segmentally resected small intestine, consisted of jejunum and ileum measuring 150 cm in length which showed 11 stenotic areas. The length of stenotic segments measured from 1 cm to 5 cm. Opening the intestine, the mucosa is relatively intact except above mentioned areas which revealed flattening of Kerckring's valves and smooth mucosal surface accompaning with irregular shaped or pin point sized ulcers. Microscopically, the stenotic areas reveal chronic granulomatous inflammation with caseous in the mucosa, submucosal Iymphoid follicles, muscular layer, subserosa and mesenteric lymph nodes. The overlying small intestinal mucosa of those areas partly or totally replaced gastric mucosa and pyloric glands. Acute nonspecific ulceration of the mucosa was also found. Mesenteric lymph nodes revealed a few number of acid fast organisms on Ziehl-Neelson stain. A brief review of the interature was done.