Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Japan.
System Biology, Graduate School of Advanced Preventive Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.
Clin J Gastroenterol. 2020 Aug;13(4):522-526. doi: 10.1007/s12328-019-01084-5. Epub 2020 Jan 1.
An 80-year-old man was admitted to our hospital with iron deficiency anemia and exertional chest pain. Coronary artery angiography showed 90% stenosis in the middle left anterior descending branch; abdominal computed tomography (CT) showed enlarged mesenteric lymph nodes. Although his past medical history and results of imaging studies did not suggest intestinal stenosis, assessment of intestinal patency with the PillCam® patency capsule (tag-less PC) was performed. Thirty-three hours after administration, excretion of tag-less PC was not confirmed; an abdominal contrast-enhanced CT showed arrest of tag-less PC in the small bowel and thickening of the bowel wall, suggesting a small bowel tumor. Four days after administration of tag-less PC, he developed abdominal pain and vomiting. Intestinal obstruction was diagnosed by abdominal radiograph. A diagnosis of small bowel tumor with intestinal obstruction was made, and surgical resection was performed. The tumor was histologically an adenocarcinoma. It is necessary to carefully evaluate gastrointestinal patency before small intestine endoscopy especially in elderly people with reduced cardiopulmonary function and many underlying diseases.
一位 80 岁男性因缺铁性贫血和劳力性胸痛而入院。冠状动脉造影显示左前降支中段 90%狭窄；腹部 CT 显示肠系膜淋巴结肿大。尽管患者既往病史和影像学检查结果均不提示存在肠道狭窄，但仍使用 PillCam®通畅胶囊（无标签 PC）进行肠道通畅评估。给药后 33 小时，仍未确认无标签 PC 的排出；腹部增强 CT 显示无标签 PC 停留在小肠且肠壁增厚，提示小肠肿瘤。给药后 4 天，患者出现腹痛和呕吐。腹部 X 线片诊断为肠梗阻。诊断为小肠肿瘤伴肠梗阻，行手术切除。肿瘤组织学检查为腺癌。在进行小肠内镜检查之前，特别是对于心肺功能下降且合并多种基础疾病的老年人，有必要仔细评估胃肠道通畅情况。
