Nishie Hirotada, Suzuki Taketo, Ichikawa Hiroshi, Kataoka Hiromi
Departments of Gastroenterology and Metabolism, Nagoya City University, Nagoya, Japan.
BMJ Case Rep. 2019 Jan 28;12(1):bcr-2018-227326. doi: 10.1136/bcr-2018-227326.
We describe a case of intestinal obstruction caused by a small bowel adenocarcinoma misdiagnosed as psychogenic disorder. A woman in her 40s was admitted to Nagoya City University Hospital with fatigue, anorexia, nausea and vomiting. CT, oesophagogastroduodenoscopy and colonoscopy revealed no signs of organic abnormality in her gastrointestinal tract. As the patient had previously been diagnosed with and treated for depression, her symptoms were suspected to be due to psychogenic disorder. Therefore, she was diagnosed with severe depression and was administered antidepressant agents. Despite intense psychiatric treatment, her symptoms worsened and she was later diagnosed with ileus due to adenocarcinoma in the jejunum. After drainage by insertion of a transnasal decompression tube, a partial jejunum resection was performed. After the resection, the patient's symptoms including fatigue and depression resolved without the use of antidepressant agents.
我们描述了一例小肠腺癌被误诊为精神性疾病而导致肠梗阻的病例。一名40多岁的女性因疲劳、厌食、恶心和呕吐入住名古屋市立大学医院。CT、食管胃十二指肠镜检查和结肠镜检查均未发现其胃肠道有器质性异常迹象。由于该患者此前曾被诊断为抑郁症并接受过治疗，其症状被怀疑是由精神性疾病引起的。因此，她被诊断为重度抑郁症并接受了抗抑郁药治疗。尽管进行了强化精神治疗，她的症状仍恶化，后来被诊断为空肠腺癌导致的肠梗阻。插入鼻减压管引流后，进行了部分空肠切除术。切除术后，患者包括疲劳和抑郁在内的症状在未使用抗抑郁药的情况下得到缓解。
