Kohga Atsushi, Kawabe Akihiro, Hasegawa Yuto, Yajima Kiyoshige, Okumura Takuya, Yamashita Kimihiro, Isogaki Jun, Suzuki Kenji, Komiyama Akira
Atsushi Kohga, Akihiro Kawabe, Yuto Hasegawa, Kiyoshige Yajima, Takuya Okumura, Kimihiro Yamashita, Jun Isogaki, Kenji Suzuki, Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Shizuoka 4180076, Japan.
World J Gastroenterol. 2017 Jan 7;23(1):167-172. doi: 10.3748/wjg.v23.i1.167.
Intraabdominal lymphangiomas are uncommon; additionally, those affecting the gastrointestinal tract are rare and account for less than 1% of cases. Intussusception caused by a cystic lymphangioma of the small bowel is extremely rare. The patient was a 20-year-old woman who visited our emergency room with a complaint of abdominal pain. A computed tomography image revealed ileo-ileal intussusception with a leading hypovascular mass measuring 1 cm in a diameter. Single-incision laparoscopic-assisted ileal resection was performed. The surgical specimen consisted of a soft polycystic mass. Macroscopically, a pedunculated polyp with a convolutional pattern was found. Microscopically, the inner surfaces of the cysts were covered with a single layer of endothelial cells. On immunohistochemical examination, the endothelial cells were partially positive for D2-40 and CD34. Smooth muscle cells were also found around the cysts. The lesion was diagnosed as a cystic lymphangioma. Dozens of cases of small bowel lymphangiomas have previously been reported. Of these, cases with intussusception were very rare. This is the first case of small bowel intussusception due to lymphangioma treated by single-incision laparoscopic-assisted surgery.
腹腔内淋巴管瘤并不常见;此外,累及胃肠道的淋巴管瘤罕见,占病例不到1%。小肠囊性淋巴管瘤引起的肠套叠极为罕见。该患者为一名20岁女性,因腹痛前来我院急诊室就诊。计算机断层扫描图像显示回肠-回肠型肠套叠,套入部有一个直径1 cm的低血运肿块。行单孔腹腔镜辅助回肠切除术。手术标本为一个柔软的多囊性肿块。肉眼可见一个有卷曲形态的带蒂息肉。显微镜下,囊肿内表面覆盖单层内皮细胞。免疫组化检查显示,内皮细胞部分D2-40和CD34阳性。囊肿周围也发现平滑肌细胞。病变诊断为囊性淋巴管瘤。此前已报道过数十例小肠淋巴管瘤病例。其中,伴有肠套叠的病例非常罕见。这是首例经单孔腹腔镜辅助手术治疗的淋巴管瘤所致小肠肠套叠病例。