Sofia Lorenzo, Lorenzini Cesare, Pergolizzi Francesca Pia, Foti Agata, Cucinotta Eugenio
Dipartimento di Patologia Umana, Cattedra di Chirurgia Generale, Università degli Studi di Messina.
Chir Ital. 2009 Jan-Feb;61(1):87-93.
An inflammatory fibroid polyp is a rare benign submucosal lesion frequently located in the gastric antrum but it may be found anywhere in the gastrointestinal tract with maximal incidence in the fifth and sixth decades of life. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils, high vascularisation and a myofibroblastic component. Its localisation in the small bowel can cause intestinal invagination in adults, a condition, that occurs most frequently in childhood where, however, it is generally not related to a pathological lesion. The diagnosis may often be delayed because of its non-specific symptoms and most cases are diagnosed at emergency laparotomy, although CT scans can furnish useful preoperative information. In the majority of cases, the treatment of choice is surgical resection. Reduction performed prior to resection proves controversial in patients with colic intussusception because of the high incidence of malignancy. We report a case of a 37-year-old man who had undergone emergency surgery for acute ileum intussusception associated with a voluminous inflammatory fibroid polyp. The case described emphasises that patients with bowel obstruction pose a complex and difficult challenge to surgeons as regards the choice of the correct diagnostic work-up and optimal therapeutic management.
炎性纤维瘤性息肉是一种罕见的良性黏膜下病变,常位于胃窦部,但也可见于胃肠道的任何部位,发病高峰在50至60岁。其主要组织学特征为伴有嗜酸性粒细胞的弥漫性炎症浸润、高度血管化以及肌成纤维细胞成分。它在小肠的定位可导致成人肠套叠,这种情况在儿童期最常见,但通常与病理性病变无关。由于其症状不具特异性,诊断往往会延迟,大多数病例在急诊剖腹手术时才得以诊断,尽管CT扫描可为术前提供有用信息。在大多数情况下,首选的治疗方法是手术切除。对于伴有绞痛性肠套叠的患者,术前复位存在争议,因为恶性肿瘤发生率较高。我们报告一例37岁男性患者,因巨大炎性纤维瘤性息肉伴急性回肠套叠接受了急诊手术。所述病例强调,对于肠梗阻患者,在选择正确的诊断检查和最佳治疗管理方面,外科医生面临着复杂而艰巨的挑战。