Bekki Tomoaki, Fukuda Toshikatsu, Moriuchi Toshiyuki, Namba Yosuke, Okimoto Sho, Mukai Shoichiro, Saito Yasufumi, Oishi Koichi, Nishida Toshihiro, Ohdan Hideki
Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Surg Case Rep. 2021 Apr 27;7(1):105. doi: 10.1186/s40792-021-01169-9.
Submucosal fecalith(s) mimicking submucosal tumors of the gastrointestinal lumen are rare. Moreover, accurate preoperative diagnosis of these entities is exceedingly difficult, and the mechanism(s) of their formation remains unclear.
A 40-year-old woman visited the authors' hospital due to lower abdominal pain and diarrhea. She had previously been treated for endometriosis. Laboratory investigation revealed increased C-reactive protein levels. Abdominal contrast-enhanced computed tomography revealed thickening of the appendix wall and dilation of the small intestine. The patient was diagnosed with paralytic ileus caused by appendicitis, and interval appendectomy was scheduled. She underwent laparoscopic-assisted appendectomy after conservative treatment. Partial cecal resection was selected due to the presence of an elastic mass in the cecum. The final pathological diagnosis was submucosal fecalith, not submucosal tumor. On day 5, the patient was discharged without any postoperative complications.
In cases of appendicitis with fecalith(s) that appear as submucosal tumor(s) on colonoscopy, submucosal fecalith mimicking submucosal tumor should be considered in the differential diagnosis.
模仿胃肠道腔黏膜下肿瘤的黏膜下粪石罕见。此外，对这些病变进行准确的术前诊断极为困难，其形成机制仍不清楚。
一名40岁女性因下腹痛和腹泻就诊于作者所在医院。她曾接受过子宫内膜异位症治疗。实验室检查显示C反应蛋白水平升高。腹部增强CT显示阑尾壁增厚和小肠扩张。患者被诊断为阑尾炎所致麻痹性肠梗阻，计划进行择期阑尾切除术。保守治疗后，她接受了腹腔镜辅助阑尾切除术。由于盲肠存在弹性肿物，选择了部分盲肠切除术。最终病理诊断为黏膜下粪石，而非黏膜下肿瘤。术后第5天，患者无任何术后并发症出院。
对于结肠镜检查显示为黏膜下肿瘤的阑尾炎合并粪石病例，鉴别诊断时应考虑模仿黏膜下肿瘤的黏膜下粪石。
