Notani Hiroyuki, Asano Daisuke, Fujiwara Naoto, Kawamura Toru, Sato Yasushi, Nakashima Akira
Dept. of Surgery, Nissan Tamagawa Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1851-1853.
A 63-year-old man visited an emergency outpatient unit with the chief complaints of melena and lightheadedness. At the time of the visit, blood tests showed Hb of 4.3 g/dL, suggesting severe anemia, and he exhibited repeated melena, even after hospitalization. Small intestinal bleeding was suspected during endoscopic examination of the lower gastrointestinal tract, and abdominalCT examination suggested a 3.5 cm tumor-like lesion in the jejunum. He was diagnosed as having bleeding of a tumor in the small intestine and consequently underwent laparoscopic surgery. Based on intraabdominal observation, Meckel 's diverticulum was confirmed in the jejunum, 100 cm from the ileocecal region, along with a 4 cm tumor in the upper jejunum, located 50 cm from Treitz's ligament. The tumor was visually confirmed to be sarcomatoid with no direct invasion to the surrounding tissues and no disseminated node, showing favorable mobility. These lesions were exteriorized from the abdominal cavity for resection and anastomosis, and the surgery was completed with no severe complications. It was diagnosed histopathologically as a gastrointestinal stromal tumor(GIST)in the small intestine, and no postoperative adjunctive chemotherapy was administered because the case was considered low risk based on the tumor diameter and the number of mitosis events. At present, 1 year after the surgery, the patient is under follow-up observation on an outpatient basis with no findings to suggest recurrence or metastasis.
一名63岁男性因黑便和头晕为主诉就诊于急诊门诊。就诊时，血液检查显示血红蛋白为4.3g/dL，提示严重贫血，即使住院后仍反复出现黑便。在下消化道内镜检查时怀疑小肠出血，腹部CT检查提示空肠有一个3.5cm的肿瘤样病变。他被诊断为小肠肿瘤出血，因此接受了腹腔镜手术。根据腹腔内观察，在距回盲部100cm的空肠中证实有梅克尔憩室，同时在上段空肠距屈氏韧带50cm处有一个4cm的肿瘤。肉眼可见肿瘤为肉瘤样，未直接侵犯周围组织，无淋巴结转移，活动度良好。这些病变从腹腔取出进行切除和吻合，手术完成后无严重并发症。组织病理学诊断为小肠胃肠道间质瘤（GIST），由于根据肿瘤直径和有丝分裂事件数量该病例被认为是低风险，因此未进行术后辅助化疗。目前，手术后1年，患者在门诊接受随访观察，未发现复发或转移迹象。
