Jejunal Choristoma: A Very Rare Cause of Abdominal Pain in Children

Choristoma is development of a normal tissue in an aberrant location. This report describes jejunal salivary choristoma (JSC) causing recurring episodes of abdominal discomfort in a 5-year-old girl. Exploratory laporatomy revealed a pale yellow subserosal jejunal lesion. Wedge resection of the lesion and repair of the bowel were performed. The child did well postoperatively and has since that time been free of pain at follow-up. Histopathological examination of the resected lesion revealed salivary gland choriostoma. Literature review (PUBMED search engine) revealed no previous report of this rare clinicopathologic entity. We conclude that choriostoma should be considered a possible differential when evaluating abdominal complaint in children. 1. Introduction Abdominal pain is a common problem in children [1]. The presentation can be acute, chronic or, recurrent. The causes are diverse and some of the commonly suspected and diagnosed causes in our clinical practice include acute appendicitis, enteritis, symptomatic inguinal or umbilical hernias, intussusception, and helminthiasis [2]. When an organic cause of recurring abdominal pain is not found or diagnosed, the child is often labelled as having nonspecific abdominal pain, a diagnosis of exclusion. Rarely a diagnosis such as choristoma is considered preoperatively a cause of the abdominal symptoms in children. Choriostoma is a form of heterotopia in which there is development of a normal tissue in an aberrant location [3]. The tissue grows at the same rate as the normal tissue and causes symptoms due to their pressure effect, ulceration, or malignant transformation. Choristomas generally are rare but they have been reported in the placenta [3]. In the gastrointestinal tract, a common site for choriostoma is in Meckel’s diverticulum which is in itself a developmental anomaly [3] and the most common ectopic tissue in the gastro-intestinal tract is pancreatic tissues occurring mostly in the stomach, duodenum and proximal jejunum [4]. Salivary choriostoma is defined as a tumor - like growth of otherwise normal salivary gland found in an abnormal location. We present the ordeals and the difficulties of management of a young Nigerian girl who had salivary gland choriostoma in the jejunum presenting as a diagnostic dilemma. 2. Case Report A 5-year-old female Nigerian child who was referred to our surgical facility on account of recurring abdominal pain. The pain was localized to the central abdomen, being colicky, aggravated by feeding and relieved occasionally by taking antacids. The episodes were frequent