Jan Zaka Ullah, Muslim Muhammad, Ullah Kaleem, Shoaib Azam, Ahmed Nisar, Khan Zainab Mahsal, Aurangzeb Mahmud
Department of General Surgery, Khyber Teaching Hospital Peshawar, Pakistan.
Ann Med Surg (Lond). 2018 Jun 26;32:14-17. doi: 10.1016/j.amsu.2018.06.006. eCollection 2018 Aug.
Vanek's tumor is a rare solitary lesion that is non-neoplastic, and arises from the submucosa of the gut. The most commonly affected sites are the stomach and the ileum [1]. IFP causing intestinal obstruction is uncommon and that ileo-ileal intussusception has been reported in the literature rarely. We present a case of an ileo-ileal intessuception in a patient who presented with acute on chronic pain abdomen and anorexia. CT abdomen & pelvis revealed a 46 × 36 mm intraluminal mass in the left iliac fossa causing ileo-ileal intussusception.
A 60 years old gentleman was brought to the A&E with a history of intestinal obstruction. He was examined and admitted to the surgical unit. CBC revealed unique feature of reactive thrombocytosis apart from a low hemoglobin and a raised TLC. His CT scan demonstrated findings of ileo-ileal intussusception. After an informed written consent, patient underwent an exploratory laparotomy and had resection and anastomosis of the bowel. Histopathology of the specimen revealed findings compatible with IFP. Patient made an uneventful recovery post-operatively and was sent home in the next few days. On follow-up, the patient was doing well and had no complaints of abdominal pain or anorexia.
Vanek's tumor although a rare entity, should be considered in each case of acute abdomen and physicians and surgeons need to have a high degree of suspicion in such cases. Moreover, IFP can cause reactive thrombocytosis that gets resolved after a post-operative period of 6-8 weeks.
瓦内克氏肿瘤是一种罕见的非肿瘤性孤立性病变，起源于肠道黏膜下层。最常受累的部位是胃和回肠[1]。导致肠梗阻的肠脂肪垂病并不常见，且文献中很少报道回肠 - 回肠套叠。我们报告一例患者，该患者因慢性腹痛急性发作和厌食就诊，检查发现回肠 - 回肠套叠。腹部及盆腔CT显示左髂窝有一个46×36mm的腔内肿块，导致回肠 - 回肠套叠。
一名60岁男性因肠梗阻病史被送往急诊科。经检查后收入外科病房。血常规检查除血红蛋白降低和白细胞计数升高外，还发现反应性血小板增多这一独特特征。他的CT扫描显示回肠 - 回肠套叠的表现。在获得知情书面同意后，患者接受了剖腹探查术，并进行了肠切除和吻合术。标本的组织病理学检查结果与肠脂肪垂病相符。患者术后恢复顺利，在接下来的几天内出院。随访时，患者情况良好，无腹痛或厌食症状。
尽管瓦内克氏肿瘤是一种罕见疾病，但在每例急腹症病例中都应予以考虑，医生和外科医生在这类病例中需要高度怀疑。此外，肠脂肪垂病可导致反应性血小板增多，术后6 - 8周可缓解。
