Recurrent intussusception caused by submucosal, heterotopic gastric mucosa in the terminal ileum

Isolated, heterotopic gastric mucosa (HGM) can be a rare, pathologic leading point for intestinal intussusception in pediatric age. Affected children often experience recurrent episodes of intussusception, sometimes with delay in diagnosis and more than one surgery, because of difficulty in clear diagnosis and identification of HGM. Intraoperative findings of isolated HGM, as reported in literature, are visible or palpable lesions, protruding into the intestinal lumen. We describe the case of a 4 years old boy with recurrent intussusception, caused by a very small islet of ileal, isolated HGM, entirely developing in the submucosal layer and with a normal overlying mucosa. The difficulties in its diagnosis and treatment are described and the role of Tc-99m pertechnetate scan and ultrasound are discussed.