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小肠脂肪瘤伴异位胃黏膜致肠套叠,在反转的梅克尔憩室内含有深囊性胃成分细胞:一例报告

Intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing gastric cystica profunda component cells within the inverted Meckel's diverticulum: a case report.

作者信息

Yamauchi Natsuko, Ito Takashi, Matsuoka Hiroki, Chohno Teruhiro, Hasegawa Hiroshi, Kakeji Yoshihiro, Ohnishi Takamasa

机构信息

Department of Surgery, Nishiwaki Municipal Hospital, 652-1 Shimotoda, Nishiwaki, Hyogo, 677-0043, Japan.

Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.

出版信息

Surg Case Rep. 2020 Nov 13;6(1):286. doi: 10.1186/s40792-020-01061-y.

Abstract

BACKGROUND

Lipomas are the most common cause of intussusception in adults. To our knowledge, however, no cases of lipoma and ectopic gastric mucosa with gastritis cystica profunda (GCP) have been reported. We report a case of intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing GCP-component cells within the inverted Meckel's diverticulum.

CASE PRESENTATION

A female in her 40s underwent computed tomography for postoperative follow-up of left breast cancer. A tumor, suspected to be a lipoma, was found in the ileum. Since there were no symptoms, the patient underwent regular follow-up. However, gradual enlargement was observed, and surgery was recommended due to the risk of intussusception. After reduction via the Hutchinson technique, laparoscopically assisted partial resection of the small intestine was performed due to suspicion that the tumor was causing intussusception starting from the ileum. Histopathologic examinations revealed proliferation of mature adipose tissue in the subserosal layer, which was diagnosed as lipoma. Furthermore, adipose tissue was found in the stem area and accordingly, we diagnosed lipoma associated with the inverted Meckel's diverticulum. Moreover, gastric mucosa-like crypt epithelium and proper glandular tissue were identified in the mucosal membrane at the area of onset, and signs of gastric pit dilatation over the submucosa and crypt epithelium hyperplasia were observed. Diagnosis was ectopic gastric mucosa containing GCP component tissue.

CONCLUSIONS

Intussusception in the small intestine complicated with lipoma and ectopic gastric mucosa with GCP within the Meckel's diverticulum has not been reported, demonstrating the rarity of our case.

摘要

背景

脂肪瘤是成人肠套叠最常见的病因。然而,据我们所知,尚无脂肪瘤与伴有深部囊性胃炎(GCP)的异位胃黏膜相关病例的报道。我们报告一例由小肠脂肪瘤引起的肠套叠病例,该脂肪瘤位于倒位梅克尔憩室内,伴有含GCP成分细胞的异位胃黏膜。

病例介绍

一名40多岁的女性因左乳腺癌术后随访接受计算机断层扫描。在回肠发现一个疑似脂肪瘤的肿瘤。由于没有症状,患者接受了定期随访。然而,观察到肿瘤逐渐增大,鉴于存在肠套叠风险,建议进行手术。通过哈钦森技术复位后,由于怀疑肿瘤从回肠开始引起肠套叠,遂行腹腔镜辅助小肠部分切除术。组织病理学检查显示浆膜下层成熟脂肪组织增生,诊断为脂肪瘤。此外,在蒂部区域发现脂肪组织,因此,我们诊断为与倒位梅克尔憩室相关的脂肪瘤。此外,在发病部位的黏膜中发现了胃黏膜样隐窝上皮和固有腺组织,并观察到黏膜下层胃小凹扩张和隐窝上皮增生的迹象。诊断为含有GCP成分组织的异位胃黏膜。

结论

小肠肠套叠合并梅克尔憩室内脂肪瘤和含有GCP的异位胃黏膜尚未见报道,表明我们的病例很罕见。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8fce/7661620/9d605513a6a0/40792_2020_1061_Fig1_HTML.jpg

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