Kato Ryo, Harada Keita, Harada Kei, Takei Daisuke, Sugihara Yuusaku, Takashima Shiho, Inokuchi Toshihiro, Takahara Masahiro, Hiraoka Sakiko, Omura Yasushi, Oda Wakako, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Division of Endoscopy, Okayama University Hospital, Okayama, Japan.
Case Rep Gastroenterol. 2017 May 17;11(2):271-276. doi: 10.1159/000475753. eCollection 2017 May-Aug.
Endoscopic submucosal dissection (ESD) is a groundbreaking treatment for tumors adjacent to the appendiceal orifice that are difficult to remove by conventional endoscopic mucosal resection, and successful cases are increasingly reported. However, little is known about the subsequent complications, especially long-term complications. A female in her early 70s with a 15-mm cecal tumor adjacent to the appendiceal orifice - discovered incidentally during a screening colonoscopy - underwent hybrid ESD of the lesion. We completely resected the tumor, and she was discharged 5 days later with a pathological diagnosis of high-grade tubular adenoma. Ten months postoperatively, she experienced sudden-onset right lower quadrant pain and was diagnosed with acute appendicitis at another hospital. Due to suspicion that her condition was the result of residual tumor, her surgeon performed an emergency laparoscopic cecectomy. The pathological examination of the resected specimen showed thick scarring adjacent to the appendiceal orifice and no residual tumor. The previous ESD was identified as the cause of the scar, and the scar was the only finding to account for the patient's appendicitis. This case is significant because the patient required additional surgery due to a complication of ESD. Further, it indicates that acute appendicitis may be a late complication of submucosal dissection near the appendiceal orifice. As ESD becomes more widely used, it is likely that more cecal tumors will be treated endoscopically. It is important to be aware of the late complications of ESD for these tumors.
内镜黏膜下剥离术（ESD）是一种开创性的治疗方法，用于治疗常规内镜黏膜切除术难以切除的阑尾开口附近的肿瘤，且成功案例报道日益增多。然而，对于其后续并发症，尤其是长期并发症，人们了解甚少。一名70岁出头的女性，在结肠镜筛查时偶然发现阑尾开口附近有一个15毫米的盲肠肿瘤，对该病变进行了内镜黏膜下剥离术联合治疗。我们完整切除了肿瘤，她在5天后出院，病理诊断为高级别管状腺瘤。术后10个月，她突然出现右下腹疼痛，在另一家医院被诊断为急性阑尾炎。由于怀疑她的病情是残留肿瘤所致，她的外科医生进行了急诊腹腔镜盲肠切除术。切除标本的病理检查显示阑尾开口附近有增厚的瘢痕，无残留肿瘤。之前的内镜黏膜下剥离术被确定为瘢痕的病因，而瘢痕是导致患者阑尾炎的唯一发现。该病例具有重要意义，因为患者因内镜黏膜下剥离术的并发症需要再次手术。此外，这表明急性阑尾炎可能是阑尾开口附近黏膜下剥离术的晚期并发症。随着内镜黏膜下剥离术的应用越来越广泛，可能会有更多的盲肠肿瘤通过内镜治疗。了解这些肿瘤内镜黏膜下剥离术的晚期并发症很重要。
