Sueoka Satoshi, Itamoto Toshiyuki, Oishi Koichi, Ishimoto Tatsuro
Hiroshima J Med Sci. 2016 Dec;65(3-4):65-68.
Intussusception in adulthood is unusual. We describe herein a rare case of adult ileoileal intussusception caused by an ileal lipoma, which was diagnosed preoperatively and was confirmed at the operation to have reduced spontaneously. A 68-year-old woman experienced sudden-onset colicky pain in the upper abdomen accompanied by vomiting and was brought to our hospital by ambulance. Physical examination revealed a distended abdomen and tenderness in the upper abdomen. Laboratory findings showed slightly elevated inflammatory parameters. Abdominal computed tomography (CT) showed a target sign in the ileum, which is a typical sign of intussusception. Additional caudal-side scans showed a homogenous and fatty mass measuring 2.5 cm that was considered to be the leading point for the invagination. These findings led to a pre-operative diagnosis of intussusception induced by a lipoma. The patient underwent emergency surgery. Laparotomy revealed a yellowish, soft ileal tumor measuring 2.5 cm in diameter and that the intussusception had already been reduced at laparotomy. Approximately 15 cm of the ileum's length, including the tumor, was resected, and an end-to-end anastomosis was performed. Adult intussusception caused by an ileal lipoma is a rare condition. However, CT is the most useful tool for making a definite preoperative diagnosis based on its typical findings.
成人肠套叠并不常见。我们在此描述一例罕见的由回肠脂肪瘤引起的成人回肠-回肠套叠病例，该病例在术前被诊断出来，手术时证实已自行复位。一名68岁女性突发上腹部绞痛并伴有呕吐，由救护车送至我院。体格检查发现腹部膨隆，上腹部有压痛。实验室检查结果显示炎症指标略有升高。腹部计算机断层扫描（CT）显示回肠有靶征，这是肠套叠的典型征象。额外的尾侧扫描显示一个2.5厘米的均匀脂肪肿块，被认为是套叠的起始点。这些发现导致术前诊断为由脂肪瘤引起的肠套叠。患者接受了急诊手术。剖腹探查发现一个直径2.5厘米的淡黄色、柔软的回肠肿瘤，且在剖腹探查时肠套叠已经复位。包括肿瘤在内的约15厘米回肠被切除，并进行了端端吻合。由回肠脂肪瘤引起的成人肠套叠是一种罕见情况。然而，基于其典型表现，CT是术前明确诊断最有用的工具。
