Har-Noy Ofir, Amitai Michal, Carter Dan
Department of Gastroenterology (Ofir Har-Noy, Dan Carter), Chaim Sheba Medical Center, Ramat Gan.
Department of Diagnostic Imaging, Chaim Sheba Medical Center, 52621 Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Michal Amitai), Israel.
Ann Gastroenterol. 2014;27(2):170-172.
A 60-year-old woman with a medical history of celiac disease was evaluated due to recurrent episodes of small bowel obstruction. Upper and lower endoscopies were normal. The small bowel pathology consisted of celiac disease, and the anti-endomysial antibody was positive. Dilatation of small bowel loops was demonstrated on abdominal computed tomography. Further evaluation was conducted using video capsule endoscopy that demonstrated regional narrowing and severe ulceration in the middle of the small bowel. Upper and lower double balloon endoscopies failed to demonstrate the lesion. On explorative laparotomy a small bowel mass in the proximal ileum was excised. Pathology revealed ulcerated, well to moderately differentiated adenocarcinoma without regional nodal involvement. We discuss the etiology and treatment of small bowel carcinoma. This case emphasizes that a high level of suspicion is required in order to diagnose early stage small bowel adenocarcinoma in celiac patients.
一名有乳糜泻病史的60岁女性因反复出现小肠梗阻发作而接受评估。上消化道和下消化道内镜检查均正常。小肠病理显示为乳糜泻，抗肌内膜抗体呈阳性。腹部计算机断层扫描显示小肠肠袢扩张。使用视频胶囊内镜进行了进一步评估，结果显示小肠中部有节段性狭窄和严重溃疡。上消化道和下消化道双气囊内镜检查未能发现病变。在剖腹探查术中，切除了回肠近端的一个小肠肿物。病理显示为溃疡型、高分化至中分化腺癌，无区域淋巴结受累。我们讨论了小肠癌病因及治疗。该病例强调，对于诊断乳糜泻患者的早期小肠腺癌需要高度怀疑。
