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腹腔镜下直肠上段套叠由巨大直肠脂肪瘤引起的直肠节段性切除术:病例报告

Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma: A case report.

作者信息

Wei Ran, Xu Wei, Xiao Yuhong, Zeng Fei, Mao Shengxun

机构信息

The First Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China.

Department of General Surgery, The Second Affiliated Hospital of Nanchang University.

出版信息

Medicine (Baltimore). 2018 Sep;97(39):e12272. doi: 10.1097/MD.0000000000012272.

Abstract

RATIONALE

Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published.

PATIENT CONCERNS

We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5 × 4.5 × 3.5 cm) was detected at the 15th centimetre of the anal canal via an electronic colonoscope. At the initial part of the rectum, intussusception caused by a 6.5-cm fat-density mass was observed via abdominal contrast-enhanced computed tomography.

DIAGNOSIS

Upper rectal intussusception caused by a giant rectal lipoma.

INTERVENTIONS

Due to the large size of the polyp, an endoscopic polypectomy could not be performed. We performed laparoscopic segmental resection of the rectum (with preservation of the left colic artery [LCA]).

OUTCOMES

The patient was discharged on the 7th postoperative day without any complications, was monitored on a regular basis at our outpatient department and was free of symptoms at a 3-month follow-up visit.

LESSONS

Laparoscopic segmental resection of the rectum with LCA preservation is safe and feasible for the treatment of upper rectal intussusception caused by a giant rectal lipoma.

摘要

原理

结肠脂肪瘤是罕见的良性肿瘤,通常无症状,多数发生于盲肠和升结肠。我们描述了一例由巨大直肠脂肪瘤引起的直肠上段套叠患者;此类病例尚无类似报道发表。

患者情况

我们报告了一例反复便血的患者。通过电子结肠镜在肛管15厘米处检测到一个广基息肉(大小为6.5×4.5×3.5厘米)。通过腹部增强CT在直肠起始部观察到一个6.5厘米脂肪密度肿块引起的套叠。

诊断

巨大直肠脂肪瘤导致直肠上段套叠。

干预措施

由于息肉体积较大,无法进行内镜下息肉切除术。我们进行了腹腔镜直肠节段性切除术(保留左结肠动脉[LCA])。

结果

患者术后第7天出院,无任何并发症,在我们门诊定期监测,3个月随访时无症状。

经验教训

保留LCA的腹腔镜直肠节段性切除术治疗巨大直肠脂肪瘤引起的直肠上段套叠安全可行。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d636/6181545/bc4d5cbe7f33/medi-97-e12272-g001.jpg

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