Griffa B, Basilico V, Feltri M, Griffa A
Divisione di Chirurgia 1, Ospedale Valduce, Como, Italy.
Minerva Chir. 2006 Dec;61(6):529-32.
A 54 year-old man, without any remarkable medical history, was examined for recurrent episodes of colicky abdominal pain, over a period of nine months, with positive faecal occult blood test. Three months earlier he had undergone an extensive evaluation for a single episode of melaena, including upper gastrointestinal endoscopy, colonoscopy to the caecum, enteroscopy and an abdominal ultrasound scan, that were negative. He was then submitted to the video capsule endoscopy (Given Imaging Ltd, Yoqneam, Israel) that revealed a polypoid white-yellowish lesion in the mid portion of the jejunum. The patient was admitted to our Department of Surgery in January 2005. During the operation, performed by laparoscopic video-assisted approach, the lesion, measuring 1.5x2 cm, was found at about 100 cm from the ligament of Treitz and was successfully excised. At histology, the final diagnosis was submucosal lymphangioma. The lymphangioma is a benign neoplastic lesion of the lymphatic system that usually is present in infancy and is found, in the majority of the patients, in the subcutaneous tissue outside the abdomen. The intrabdominal site accounts for less than 1% of the cases, and often occurs in the mesentery of the small bowel. Finding the lesion in the submucosa of the jejunum in an adult is very rare. The case here reported seems unusual to the Authors and worthy of publication because of the chronic, ambiguous clinical symptomatology, the occult digestive blood loss, and all the diagnostic examinations resulting negative, except for the video-capsule endoscopy. Moreover, the choice of the laparoscopic video-assisted technique, confirming the expected site of the lesion, with a ''minimal'' small bowel resection, made the postoperative course of the patient very short and uneventful. He is well and free of disease one year after the intervention. From a brief review of surgical literature, the case reported is the second one detected by the video capsule endoscopy and the fifth operated on by laparoscopy.
一名54岁男性，无显著病史，因反复发作的绞痛性腹痛9个月且粪便潜血试验呈阳性而接受检查。3个月前，他因一次黑便接受了全面评估，包括上消化道内镜检查、结肠镜检查至盲肠、小肠镜检查和腹部超声扫描，结果均为阴性。随后他接受了视频胶囊内镜检查（以色列约内阿姆的Given Imaging Ltd公司生产），发现空肠中部有一个息肉样黄白色病变。该患者于2005年1月入住我们的外科。手术采用腹腔镜视频辅助方法进行，发现病变位于距屈氏韧带约100 cm处，大小为1.5×2 cm，成功切除。组织学检查最终诊断为黏膜下淋巴管瘤。淋巴管瘤是淋巴系统的一种良性肿瘤性病变，通常在婴儿期出现，大多数患者的病变位于腹部以外的皮下组织。腹腔内病变占病例不到1%，且常发生于小肠系膜。在成人空肠黏膜下发现该病变非常罕见。本文作者认为该病例不同寻常且值得发表，原因在于其慢性、模糊的临床症状、隐匿性消化道失血以及除视频胶囊内镜检查外所有诊断检查结果均为阴性。此外，腹腔镜视频辅助技术的选择，确定了病变的预期位置，进行了“最小限度”的小肠切除，使患者术后病程非常短且顺利。干预后一年，他情况良好且无疾病。通过对手术文献的简要回顾，该病例是第二例通过视频胶囊内镜检查发现且第五例通过腹腔镜手术治疗的病例。
