Sanchez Caroline, Brody Fred, Pucci Edward, Bashir Showkat
Department of General Surgery, Division of Gastroenterology and Liver Disease, The George Washington University Medical Center, Washington, DC 20037, USA.
J Laparoendosc Adv Surg Tech A. 2007 Feb;17(1):32-5. doi: 10.1089/lap.2006.05094.
Most patients with Ménétrier's disease are treated nonoperatively with nutritional support, antacids, and pain medications. Surgical intervention is rarely required. We report the case of a 41-year-old male with HIV and hepatitis B who presented with weight loss, abdominal pain, nausea, and vomiting. A computed tomography scan of the abdomen showed diffuse gastric thickening without lymphadenopathy and an upper endoscopy revealed chronic gastritis and enlarged gastric folds without evidence of Helicobacter pylori. Multiple endoscopic biopsies showed chronic inflammation without malignancy. A laparoscopic assisted full thickness biopsy revealed foveolar hyperplasia consistent with Ménétrier's disease. Postoperatively, the patient's symptoms continued to worsen and were complicated by lower gastrointestinal bleeding secondary to gastric erosions. The patient did not experience any hematemesis, only melena. A laparoscopic total gastrectomy with a Roux-en-Y esophagojejunostomy was performed. The patient was discharged home on postoperative day 7 tolerating a postgastrectomy diet. His hematocrit stabilized and he remained asymptomatic at 16-month follow-up. Ménétrier's disease is a rare gastrointestinal entity that can be treated safely with minimally invasive skills. We report this case in detail and discuss Ménétrier's disease.
大多数门脉性胃病患者采用营养支持、抗酸剂和止痛药物进行非手术治疗。很少需要手术干预。我们报告一例41岁男性患者，患有艾滋病毒和乙型肝炎，出现体重减轻、腹痛、恶心和呕吐症状。腹部计算机断层扫描显示胃弥漫性增厚，无淋巴结肿大，上消化道内镜检查显示慢性胃炎和胃皱襞增大，未发现幽门螺杆菌。多次内镜活检显示为慢性炎症，无恶性病变。腹腔镜辅助全层活检显示胃小凹增生，符合门脉性胃病。术后，患者症状持续恶化，并因胃糜烂继发下消化道出血而出现并发症。患者未出现呕血，仅出现黑便。进行了腹腔镜全胃切除术并 Roux-en-Y 食管空肠吻合术。患者术后第7天出院，能耐受胃切除术后饮食。他的血细胞比容稳定，在16个月的随访中无症状。门脉性胃病是一种罕见的胃肠道疾病，可通过微创技术安全治疗。我们详细报告该病例并讨论门脉性胃病。
