Gastric heterotopia (GH) is rare in ileum except in Meckel’s diverticulum and rarely causes severe symptoms in adults. Here, we report a 31-year-old male patient with GH in ileum presented with bowel perforation and mass formation in the mesentery mimicking perforated small bowel tumor. Microscopic examination of the lesion showed completely differentiated gastric body-type mucosa with mucosal ulceration, fistula formation and bowel perforation. This case raises the awareness that GH may cause severe complications and should be included in the differential diagnosis for acute abdominal pain especially in patients with a mass lesion at an unusual location.
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