Turculeţ Claudiu, Ene Dragoş, Georgescu Teodor Florin, Ciucă E, Vlădăşcău A, Iordache Florin, Beuran Mircea
Chirurgia (Bucur). 2016 Nov-Dec;111(6):505-508. doi: 10.21614/chirurgia.111.6.505.
We present the case of a 48-year-old patient with no medical history, who presents himself to the emergency room with melena, asthenia and dizziness. The blood tests revealed a severe anemia (Hb = 4,8 g/dL). He is admitted in the Gastroenterology ward, where a first superior digestive endoscopy is performed which shows a duodenal bleeding tumor (second duodenum) of 7 cm in length. After the administration of red blood cell mass, plasma and haemostatic agents the level of the hemoglobin increases. The abdominal CT scan reveals a 3/5 tumor localized in the second and third duodenum. The superior digestive endoscopy is repeated and haemostasis of the bleeding tumor is accomplished. The surgical exploration of the peritoneal cavity discovered a partial stenosing, ulcerated duodenal tumor (third and fourth duodenum) and duodenectomy (third and fourth duodenum), segmental enterectomy (first loop of the jejunum), end to end duodeno-jejunal anastomosis, transgastric closure of the pylorus, gastro-enteric anastomosis on Omega loop with Braun fistula were performed, after the result of the extemporaneous histopathological exam suggested a GIST tumor. The postoperative evolution was favorable. The histopathological exam diagnosed the duodenal tumor as a gastrointestinal stromal tumor (GIST) with tumor free resection margins. The particularity of this case is the rare etiology of the upper gastrointestinal hemorrhage and its severity.
我们报告一例48岁无病史患者，其因黑便、乏力和头晕前往急诊室就诊。血液检查显示严重贫血（血红蛋白=4.8g/dL）。他被收入胃肠病科病房，在那里进行了首次上消化道内镜检查，发现一个长7厘米的十二指肠出血性肿瘤（十二指肠第二段）。输注红细胞悬液、血浆及止血药物后，血红蛋白水平升高。腹部CT扫描显示一个3/5大小的肿瘤位于十二指肠第二和第三段。再次进行上消化道内镜检查并实现了出血肿瘤的止血。对腹腔进行手术探查发现一个部分狭窄、溃疡的十二指肠肿瘤（十二指肠第三和第四段），遂行十二指肠切除术（十二指肠第三和第四段）、节段性肠切除术（空肠第一段）、十二指肠空肠端端吻合术、经胃幽门关闭术、Omega袢胃肠吻合术加布劳恩吻合术，术中组织病理学检查结果提示为胃肠道间质瘤（GIST）。术后病情进展顺利。组织病理学检查诊断十二指肠肿瘤为胃肠道间质瘤（GIST），切缘无肿瘤残留。该病例的特殊性在于上消化道出血病因罕见且病情严重。
