Kikuchi Nozomi, Miyakura Yasuyuki, Takahashi Jun, Takayama Noriya, Tamaki Sawako, Ishikawa Hideki, Kakizawa Nao, Hasegawa Fumi, Kikugawa Rina, Tsujinaka Shingo, Lefor Alan Kawarai, Rikiyama Toshiki
Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, Japan.
Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
J Surg Case Rep. 2018 Jul 3;2018(7):rjy152. doi: 10.1093/jscr/rjy152. eCollection 2018 Jul.
We report a patient with a descending colon lipoma presenting with hematochezia who developed intussusception, which was simultaneously accompanied by acute appendicitis. A 43-year-old man presented with hematochezia. Colonoscopy revealed a submucosal tumor with a reddish surface in the descending colon. A solid mass with fat density value measuring 5 cm in diameter was observed in the descending colon on CT. While awaiting elective resection, the patient developed lower abdominal pain. CT demonstrated antegrade colo-colonic intussusception in the descending colon. Simultaneously, the appendix was inflamed with a high density intraluminal lesion suspected to be a fecalith. The diagnosis of simultaneous intussusception and acute appendicitis was made. Appendectomy and partial resection of the descending colon was performed. Histopathological examination was consistent with descending colon lipoma and acute appendicitis. The mechanism for developing hematochezia and the risk for development of colo-colonic intussusception due to large colon lipoma and acute appendicitis were highlighted.
我们报告一例降结肠脂肪瘤患者，表现为便血，并发肠套叠，同时伴有急性阑尾炎。一名43岁男性出现便血。结肠镜检查发现降结肠有一个表面呈红色的黏膜下肿瘤。CT显示降结肠有一个直径5 cm、密度值为脂肪密度的实性肿块。在等待择期切除期间，患者出现下腹痛。CT显示降结肠发生顺行性结肠-结肠套叠。同时，阑尾发炎，腔内有一个高密度病变，怀疑是粪石。诊断为同时发生肠套叠和急性阑尾炎。行阑尾切除术和降结肠部分切除术。组织病理学检查结果符合降结肠脂肪瘤和急性阑尾炎。强调了便血的发生机制以及大肠脂肪瘤和急性阑尾炎导致结肠-结肠套叠的风险。
