Hirasaki Shoji, Kubo Motoharu, Inoue Atsushi, Miyake Yasuyuki, Oshiro Hisako
Division of Gastroenterology, Kubo Hospital, 1-1-19 Uchibori, Imabari 7992116, Japan.
World J Gastroenterol. 2009 Aug 21;15(31):3954-6. doi: 10.3748/wjg.15.3954.
Intussusception is rare in adults. We describe a 62-year-old man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdominal pain. Plain abdominal radiography showed some intestinal gas and fluid levels. Abdominal CT scan demonstrated a target sign suggesting bowel intussusception. Jejunography using a naso-jejunal tube showed an oval-shaped mass about 15 mm in diameter with a smooth surface in the jejunum, which suggested a submucosal tumor (SMT), and edematous mucosa around the mass. Partial jejunal resection was carried out and the resected oval-shaped tumor, 14 mm x 11 mm in size, was found to be covered with normal jejunal mucosa. The tumor was histologically diagnosed as type III ectopic pancreas according to the classification proposed by Heinrich. Abdominal pain resolved postoperatively. This case reminds us that jejunal ectopic pancreas should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.
肠套叠在成年人中较为罕见。我们描述了一名62岁男性，其空肠异位胰腺导致空肠-空肠套叠和肠梗阻。该患者因间歇性腹痛入院。腹部平片显示一些肠内气体和液平面。腹部CT扫描显示靶征，提示肠套叠。经鼻空肠管进行的空肠造影显示空肠内有一个直径约15毫米、表面光滑的椭圆形肿块，提示黏膜下肿瘤（SMT），且肿块周围黏膜水肿。进行了部分空肠切除术，切除的椭圆形肿瘤大小为14毫米×11毫米，发现其被正常空肠黏膜覆盖。根据海因里希提出的分类，该肿瘤经组织学诊断为III型异位胰腺。术后腹痛缓解。该病例提醒我们，空肠异位胰腺应纳入肠道SMT所致肠套叠的鉴别诊断中。
