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[一例酷似克罗恩病的回盲部异物:病例报告]

[An ileo-caecal foreign body mimicking a Crohn disease: case report].

作者信息

Montacer Khaoula El, Haddad Fouad, Mansouri Souhaila El, Tahiri Mohammed, Hliwa Wafaa, Bellabah Ahmed, Badre Wafaa

机构信息

Service d'Hépato-Gastro-Entérologie, Ibn Rochd, Casablanca, Maroc.

出版信息

Pan Afr Med J. 2018 Dec 19;31:236. doi: 10.11604/pamj.2018.31.236.16816. eCollection 2018.

Abstract

Foreign-body ingestion is a common cause of admission to the Division of Gastroenterology. However foreign-body lodged in the ileocecal region is very rare. This study aims to report the exceptional case of a patient with a foreign body lodged in the ileocecal region revealed by sub-occlusive syndromes. The study involved a patient aged 22 years with no particular past medical history, presenting with König's syndrome evolving in a context of alteration of the general state. Anatomopathological examination of surgical ileocecal specimen performed after inconclusive endoscopy, histologic examination of the biopsies and scannography, showed ileocecal thickening due to infammatory response to a foreign body. In the absence of anamnestic data, ileocecal foreign body poses a real problem of differential diagnosis including inflammatory, infectious and tumoral diseases of the ileocecal junction. The presence of a foreign body may be revealed by occlusive complications or perforations, hence the essential role of imaging. Endoscopy always plays a central diagnostic and therapeutic role in the management of ingested foreign bodies, thus reducing surgical morbidity (although it is sometimes unavoidable). Anatomopathological study shows foreign body granuloma. Cases of foreign body lodged in the ileocecal region have been rarely reported. Now they should be suspected in patients with any symptom, including ileocecal junction disorders, in order to avoid side effects and complications due to heavy treatments.

摘要

异物摄入是导致患者入住胃肠病科的常见原因。然而,异物嵌顿在回盲部的情况非常罕见。本研究旨在报告一例因亚梗阻综合征而发现异物嵌顿在回盲部的特殊病例。该研究涉及一名22岁、无特殊既往病史的患者,其以柯尼格综合征为表现,且全身状况出现改变。在内镜检查结果不明确后对手术切除的回盲部标本进行的解剖病理学检查、活检组织学检查及扫描检查显示,回盲部增厚是由于对异物的炎症反应所致。在缺乏既往病史资料的情况下,回盲部异物会带来真正的鉴别诊断难题,包括回盲部的炎症性、感染性和肿瘤性疾病。异物的存在可能通过梗阻并发症或穿孔表现出来,因此影像学检查至关重要。在内镜检查在处理摄入异物的过程中始终发挥着核心的诊断和治疗作用,从而降低手术发病率(尽管有时不可避免)。解剖病理学研究显示为异物肉芽肿。异物嵌顿在回盲部的病例鲜有报道。现在,对于出现任何症状(包括回盲部疾病)的患者都应怀疑有异物存在,以便避免过度治疗带来的副作用和并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca7b/6691309/3fb0ff1ebbcc/PAMJ-31-236-g001.jpg

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