Boehm R, Till H, Landes J, Schmid I, Joppich I
Paediatric Surgical Department, University of Munich, Munich, Germany.
Eur J Pediatr Surg. 2003 Aug;13(4):272-5. doi: 10.1055/s-2003-42234.
Intussusception typically occurs in childhood, presenting with a well-known medical history and clinical symptoms. Pathologically, a "leading point" may be attributed to lymphadenomatosis, polyps, or a tumour. In older patients and adolescents, the diagnosis can be complicated due to the lower incidence and variable subacute symptoms. We report on an 18-year-old patient with increasing abdominal discomfort over several weeks. External diagnostics showed no pathological signs or were misinterpreted as a malfunction of intestinal motility. The patient experienced increasing colics, recurrent vomiting, dehydration and weight loss. Finally he was transferred to our paediatric surgical department and laparotomy had to be performed for the clinical and radiological signs of an ileus. An ileoilealic intussusception was found, caused by a small bowel tumour, which almost completely obstructed the intestinal lumen. It was resected and bowel continuity was re-established. Histopathology revealed a very rare, highly malignant mesenchymal Ewing sarcoma, infiltrating the complete bowel wall. After the postoperative course, the patient was transferred to our oncological department for chemotherapy. In older children or young adults, intestinal malignancies are extremely rare. Nevertheless, if these patients suffer from unspecific complaints of chronic intestinal obstruction, a tumour must be ruled out. A Ewing sarcoma may be responsible for an intussusception.
肠套叠通常发生于儿童期，具有众所周知的病史和临床症状。病理上，“引导点”可能归因于淋巴瘤、息肉或肿瘤。在老年患者和青少年中，由于发病率较低且症状亚急性多变，诊断可能会很复杂。我们报告一名18岁患者，数周来腹部不适逐渐加重。外部诊断未显示病理体征或被误诊为肠道动力障碍。患者绞痛加剧，反复呕吐，出现脱水和体重减轻。最终，他被转至我们的小儿外科，因肠梗阻的临床和放射学征象而不得不进行剖腹手术。发现为回肠-回肠型肠套叠，由小肠肿瘤引起，几乎完全阻塞肠腔。肿瘤被切除，肠管连续性得以重建。组织病理学显示为一种非常罕见的、高度恶性的间叶性尤因肉瘤，浸润整个肠壁。术后，患者被转至我们的肿瘤科进行化疗。在大龄儿童或青年成人中，肠道恶性肿瘤极为罕见。然而，如果这些患者患有慢性肠梗阻的非特异性主诉，必须排除肿瘤。尤因肉瘤可能是肠套叠的病因。
