Yoshii Hisamichi, Izumi Hideki, Tajiri Takuma, Mukai Masaya, Nomura Eiji, Makuuchi Hiroyasu
Department of Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan.
Tokai J Exp Clin Med. 2020 Jul 20;45(2):75-80.
The patient was a 72-year-old man who consulted with his previous physician for chief complaints of palpitations, fatigue, and blackish feces persisting for 1 month. After confirming the presence of anemia, the patient was referred to our hospital. Blood test findings upon hospital arrival revealed a hemoglobin (Hb) level of 6.0 g/dL. Computed tomography revealed a tumor of 32 mm × 30 mm with a low-density area extending from the bulb to the second part of the duodenum. Magnetic resonance imaging revealed high signal intensity on T1- and T2-weighted imaging and low signal intensity on fat-suppressed T2-weighted imaging, findings consistent with lipoma. Upper gastrointestinal endoscopy revealed a yellowish submucosal tumor that had perforated into the intestinal tract from the external wall extending from the upper corner to the second part of the duodenum. After determining that the tumor was sessile, laparoscopic partial duodenectomy with Roux-en-Y reconstruction was planned and performed. Pathology revealed a yellowish tumor 4 cm × 4 cm in size extending from the pyloric area to the duodenal bulb arising from the tunica muscularis. The present case report details our experience involving a patient who underwent surgical resection for hemorrhagic duodenal lipoma.
患者为一名72岁男性,因心悸、乏力及黑便持续1个月,此前向其医生咨询。确诊贫血后,患者被转诊至我院。入院时血液检查结果显示血红蛋白(Hb)水平为6.0 g/dL。计算机断层扫描显示一个32 mm×30 mm的肿瘤,低密度区域从十二指肠球部延伸至十二指肠第二部。磁共振成像显示在T1加权成像和T2加权成像上呈高信号强度,在脂肪抑制T2加权成像上呈低信号强度,这些表现符合脂肪瘤。上消化道内镜检查发现一个淡黄色黏膜下肿瘤,该肿瘤已从十二指肠上缘至第二部的外壁穿入肠道。确定肿瘤为无蒂后,计划并实施了腹腔镜下十二指肠部分切除术及Roux-en-Y重建术。病理检查显示一个大小为4 cm×4 cm的淡黄色肿瘤,从幽门区延伸至十二指肠球部,起源于肌层。本病例报告详细介绍了我们对一名因出血性十二指肠脂肪瘤接受手术切除患者的治疗经验。