Abbasakoor Noormuhammad O, Kavanagh Dara O, Moran Diarmaid C, Ryan Barbara, Neary Paul C
Division of Colorectal Surgery, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland.
J Med Case Rep. 2010 Feb 11;4:51. doi: 10.1186/1752-1947-4-51.
The occurrence of intussusception in adults is rare. The condition is found in 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. The child to adult ratio is 20:1.
A 52-year-old Irish Caucasian woman was investigated for a 3-month history of intermittent episodes of colicky midgut pain and associated constipation. Ileocolonoscopy revealed a pedunculated lesion in the terminal ileum prolapsing into the caecum. Computed tomography confirmed a smooth-walled, nonobstructing, low density intramural lesion in the terminal ileum with secondary intussusception. A laparoscopic small bowel resection was performed. Histology revealed a large pedunculated polypoidal mass measuring 4 x 2.5 x 2 cm consistent with a submucosal lipoma. She had complete resolution of her symptoms and remained well at 12-month follow-up.
This case highlights an unusual cause of incomplete small bowel obstruction successfully treated through interdisciplinary cooperation. Ileal lipomas are not typically amenable to endoscopic removal and require resection. This can be successfully achieved via a laparoscopic approach with early restoration of premorbid functioning.
成人肠套叠的发生率很低。在1300例腹部手术中会出现1例,在100例因肠梗阻接受手术的患者中会出现1例。儿童与成人的发病比例为20:1。
一名52岁的爱尔兰白人女性因间歇性中肠绞痛伴便秘3个月的病史接受检查。回结肠镜检查发现回肠末端有一个带蒂病变,脱垂至盲肠。计算机断层扫描证实回肠末端有一个壁光滑、无梗阻、低密度的壁内病变,并伴有继发性肠套叠。进行了腹腔镜小肠切除术。组织学检查显示一个带蒂的息肉样大肿块,大小为4×2.5×2厘米,符合黏膜下脂肪瘤。她的症状完全缓解,在12个月的随访中情况良好。
本病例突出了一种通过多学科合作成功治疗的不完全性小肠梗阻的罕见病因。回肠脂肪瘤通常不适合内镜切除,需要进行切除。通过腹腔镜手术可以成功实现切除,并能早期恢复病前功能。