Sahoo Manash Ranjan, Nayak Anil Kumar, Pattanaik Akshapada, Gowda Manoj S
Department of General Surgery, S.C.B. Medical College & Hospital, Cuttack, Odisha, India.
BMJ Case Rep. 2014 May 26;2014:bcr2013008760. doi: 10.1136/bcr-2013-008760.
A 45-year-old man presented to the emergency ward with features of intestinal obstruction of 2 days duration. On admission, there was abdominal distension and multiple sessile polyps found on digital rectal examination. In addition, a soft tissue swelling near the elbow and a bony swelling over scalp were noted. Abdominal radiography revealed gaseous distension of the small and large bowel, and ultrasound revealed diffuse, gas-filled bowel with sluggish peristalsis. The obstruction failed to resolve with conservative measures and at emergency laparotomy an irregular hard recto-sigmoid junction mass was identified. A defunctioning transverse loop colostomy was undertaken and the abdomen closed. During recovery, a colonoscopy was performed and a malignant appearing lesion was identified 15 cm proximal to the anal verge. Further per-stomal colonoscopy revealed multiple sessile polyps from the ileo-caecal valve to the descending colon. The cutaneous and abdominal findings were consistent with a rare acute presentation of Gardner's syndrome.
一名45岁男性因持续2天的肠梗阻症状就诊于急诊病房。入院时，腹部膨隆，直肠指检发现多个无蒂息肉。此外，还注意到肘部附近有软组织肿胀以及头皮上有骨性肿胀。腹部X线检查显示小肠和大肠均有气体扩张，超声检查显示肠管弥漫性充气且蠕动缓慢。保守治疗后梗阻未缓解，急诊剖腹探查时发现乙状结肠直肠交界处有一不规则硬块。遂行横结肠袢式造口术，关闭腹腔。恢复期间，进行了结肠镜检查，在距肛缘15厘米处发现一个疑似恶性病变。进一步的造口周围结肠镜检查显示，从回盲瓣到降结肠有多个无蒂息肉。皮肤和腹部表现符合加德纳综合征罕见的急性表现。
