A Case of an Ileus due to Multiple Small Intestine Fistula Caused by Heterotopic Gastric Mucosa with Ileal Duplication

Takami Fukui, Naoki Yokoo, Takahiro Yoshida, Chihiro Tanaka Tatsushi Kato, Hisaya Azuma, Takashi Shiroko, Tetsuya Yamaguchi and Kiyonao Okamoto^*

Department of Surgery and Department of Pathology^*, Takayama Red Cross Hospital

We experienced a rare case of ileal duplication with multiple fistula and heterotopic gastric mucosa in the small intestine which was detected because of an ileus. A71-year-old woman was admitted to our hospital with nausea, vomiting and abdominal distention. On admission physical examination revealed tenderness and muscle guarding at the lower abdomen. Plain abdominal X-ray and abdominal CT showed dilated loops of the small intestine. An emergency laparotomy was carried out. During the laparotomy, one fistula which was at the jejunum 130 cm from the ligament of Treitz were found. Adhesions of the dilated small intestine and an ileal duplication 100cm from the ileum end were found. In addition, three fistulas which were in the dilated small intestine were found. The dilated small intestine including the ileal duplication and the fistula at the jejunum were resected. Histological examination revealed some gastric-pyloric glands in the small intestine specimen. These findings suggest that the fistula, due to heterotopic gastric mucosa, caused the ileus.

Key words
ileal duplication, heterotopia of gastric mucosa, multiple fistulas in the small intestine

Reprint requests
Takami Fukui Department of Surgery, Takayama Red Cross Hospital 3-11 Tenman-cho, Takayama City, 506-8550 JAPAN

Accepted
March 31, 1999

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