Sou Suketo, Nomura Hideyuki, Takaki Yasuhiro, Nagahama Takashi, Matsubara Fujio, Matsui Toshiyuki, Yao Tsuneyoshi
Department of Gastroenterology, Shin-Kokura Hospital, Kanada, Kokurakita-ku, Kitakyushu, Japan.
J Gastroenterol Hepatol. 2006 Feb;21(2):479-81. doi: 10.1111/j.1440-1746.2006.03178.x.
The patient, an 81-year-old woman, was admitted to our hospital for a detailed examination; the chief complaint being melena. An upper gastrointestinal roentgenologic study revealed a submucosal tumor with a smooth surface and a stalk measuring 50 mm at the third part of the duodenum. Endoscopy depicted it as a yellowish submucosal tumor. Based on computed tomography and fluoroscopy of the small intestine, a diagnosis of duodenal lipoma was made. The esophagus, stomach, and the small and large intestines were free of lesions so the duodenal lipoma was judged to be the hemorrhagic source. The tumor was endoscopically polypectomized using a 2-channel scope. The excised specimen, measuring 50 x 20 x 20 mm, was covered by a normal duodenal mucosa with small ulcers in part. Photomicrographic findings included a tumor that was composed of mature adipose tissue in the submucosa, which coincided with a diagnosis of lipoma. Small ulcers had formed in part, exposing vessels, thus indicating the cause for hemorrhage. Lipoma is a benign tumor; and if the lesion is found to be pedunculated and an endoscope can reach it for treatment, minimally invasive endoscopic procedures should be selected.
患者为一名81岁女性，因黑便入院接受详细检查。主要症状为黑便。上消化道X线检查显示十二指肠第三段有一个表面光滑、带蒂的黏膜下肿瘤，长50毫米。内镜检查显示为淡黄色黏膜下肿瘤。基于小肠计算机断层扫描和荧光镜检查，诊断为十二指肠脂肪瘤。食管、胃以及小肠和大肠均无病变，因此判断十二指肠脂肪瘤为出血源。使用双通道内镜对肿瘤进行了内镜下息肉切除术。切除的标本大小为50×20×20毫米，部分被正常十二指肠黏膜覆盖，有小溃疡。显微镜下所见包括一个由黏膜下成熟脂肪组织构成的肿瘤，这与脂肪瘤的诊断相符。部分形成了小溃疡，暴露了血管，从而表明了出血原因。脂肪瘤是一种良性肿瘤；如果发现病变有蒂且内镜能够到达进行治疗，应选择微创内镜手术。
