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[一例因乙状结肠癌导致的肠套叠病例]

[A Case of Intussusception Due to Sigmoid Colon Cancer].

作者信息

Hongo Maiko, Inaba Yoko, Kotake Kenjiro

机构信息

Dept. of Gastroenterology and Surgery, Sano City Hospital.

出版信息

Gan To Kagaku Ryoho. 2019 Jan;46(1):115-117.

Abstract

A 78-year-old man was referred to our hospital with diarrhea, melena, and weight loss. During a digital rectal examination, a protuberant mass located 7-8 cm above the anal verge was palpable. Computed tomography(CT)scans of his chest, abdomen, and pelvis revealed an intestinal obstruction with a target sign in the lower rectum, indicating intussusception due to a sigmoid colon mass. A gastrografin enema examination revealed a typical filling defect with a crab claw sign in the rectum. However, the enema did not reduce the intussusception. The surgical findings showed that the sigmoid colon had slipped inside the rectum, consistent with the diagnostic imaging findings. A radical sigmoidectomy(D2)with diverting colostomy was performed to address the unprepared colon with accompanying edema. Pathology of the resected specimen revealed a type 2 tumor measuring 5 cm in size and comprising moderately differentiated adenocarcinoma(pT3pN0M0, pStage Ⅱ). The patient's postoperative course was uneventful, and his stoma was closed 2 months later. Intussusception occurs less frequently in adults than in children. In a case of bowel-within-bowel configuration, in which layers of the bowel are duplicated to form concentric rings, the target-like sign on CT images may be a useful diagnostic marker of colorectal intussusception.

摘要

一名78岁男性因腹泻、黑便和体重减轻被转诊至我院。在直肠指检时,可触及距肛门边缘7 - 8厘米处有一突出肿块。其胸部、腹部和骨盆的计算机断层扫描(CT)显示下直肠有肠梗阻及靶征,提示乙状结肠肿块导致的肠套叠。泛影葡胺灌肠检查显示直肠有典型的充盈缺损及蟹爪征。然而,灌肠未能复位肠套叠。手术所见显示乙状结肠滑入直肠内,与诊断性影像学检查结果相符。为处理伴有水肿的未准备好的结肠,实施了根治性乙状结肠切除术(D2)并做了转流性结肠造口术。切除标本的病理显示为2型肿瘤,大小为5厘米,由中分化腺癌组成(pT3pN0M0,pⅡ期)。患者术后恢复顺利,2个月后关闭了造口。肠套叠在成人中比在儿童中少见。在肠中肠结构的病例中,肠壁各层重复形成同心圆,CT图像上的靶样征可能是结直肠肠套叠的有用诊断标志物。

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