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无肺部表现的广泛腹部结节病

Extensive Abdominal Sarcoidosis Without Pulmonary Manifestation.

作者信息

Alatmi Abdulaziz, Joury Abdulaziz U, Mubarak Abeer

机构信息

Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.

出版信息

Ochsner J. 2019 Summer;19(2):174-177. doi: 10.31486/toj.17.0111.

Abstract

Sarcoidosis is a rare multisystem disease of idiopathic etiology that affects different organs and is characterized histopathologically by the presence of noncaseating granulomas. The most common location of sarcoidosis is the lungs, accounting for approximately 95% of sarcoidosis cases. Coincident involvement of pulmonary and extrapulmonary organs is present in approximately one-third of patients. However, the sole involvement of intraabdominal organs is extremely rare. Intraabdominal sarcoidosis has a different presentation depending on the involved organs. To the best of our knowledge, a limited number of case reports have been published on intraabdominal sarcoidosis without pulmonary involvement. A 69-year-old female patient presented with short onset of abdominal pain and change in bowel habits, without a significant medical history of abdominal problems. Physical examination only revealed generalized abdominal tenderness on deep palpation. Computed tomography of the abdomen and pelvis showed mild to moderate thickening of the omentum and other abdominal organs. After excluding various etiologies such as fungi and acid-fast bacilli, the omentum, ovaries, and surrounding lymph nodes were removed via a laparoscopic procedure. The histopathology report confirmed the diagnosis of intraabdominal sarcoidosis with the presence of noncaseating granulomas. Extrapulmonary sarcoidosis is a rare disease, and intraabdominal sarcoidosis might mimic other malignant etiologies. We treated our case with laparoscopic removal of involved organs and oral steroids with significant recovery during a short period.

摘要

结节病是一种病因不明的罕见多系统疾病,可累及不同器官,组织病理学特征为非干酪样肉芽肿的存在。结节病最常见的部位是肺部,约占结节病病例的95%。约三分之一的患者同时存在肺和肺外器官受累。然而,单纯腹腔内器官受累极为罕见。腹腔内结节病根据受累器官的不同有不同的表现。据我们所知,关于无肺部受累的腹腔内结节病的病例报告数量有限。一名69岁女性患者出现腹痛起病急和排便习惯改变,既往无明显腹部疾病病史。体格检查仅显示深触诊时全腹压痛。腹部和盆腔计算机断层扫描显示大网膜和其他腹部器官轻度至中度增厚。在排除真菌和抗酸杆菌等各种病因后,通过腹腔镜手术切除大网膜、卵巢及周围淋巴结。组织病理学报告证实为腹腔内结节病,存在非干酪样肉芽肿。肺外结节病是一种罕见疾病,腹腔内结节病可能会模仿其他恶性病因。我们对该病例采用腹腔镜切除受累器官和口服类固醇治疗,短期内有显著恢复。

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