Lola Y Kwan, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States.
World J Gastroenterol. 2011 May 21;17(19):2446-9. doi: 10.3748/wjg.v17.i19.2446.
Small bowel tumors and Crohn's disease are common causes of small bowel obstruction. Early stage neoplasms can easily be mistaken for Crohn's disease. Therefore, thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis. Here we report a case of an otherwise healthy female with progressive onset of multiple, recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn's disease. After thorough evaluation, the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum. In this case, a delay in diagnosis can be detrimental for prognosis, as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and/or resection.
小肠肿瘤和克罗恩病是小肠梗阻的常见原因。早期肿瘤很容易被误诊为克罗恩病。因此，包括影像学检查和内镜评估在内的彻底检查对于准确诊断至关重要。在这里，我们报告了一例无其他健康问题的女性，她因末端回肠狭窄而逐渐出现多发性、反复性梗阻症状，被转诊为类固醇依赖型克罗恩病的治疗。经过彻底评估，诊断被修订为累及末端回肠的髓系粒细胞肉瘤。在这种情况下，诊断的延误可能对预后不利，因为髓系粒细胞肉瘤高度提示潜在的急性髓系白血病，需要紧急转介进行化疗和/或切除。
