Okamoto Takeshi, Suzuki Hidekazu, Fukuda Katsuyuki
Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo 104-8560, Japan.
Department of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1143, Japan.
Case Rep Gastrointest Med. 2021 Jul 12;2021:3718089. doi: 10.1155/2021/3718089. eCollection 2021.
Despite improvements in imaging modalities, causative lead points in adult intussusception may be difficult to diagnose. Such lead points can be malignant, causing recurrence or metastases if left unresected. We describe a case of transient adult jejunojejunal intussusception, in which intraoperative endoscopy was used to confirm the absence of a lead point. A 39-year-old woman with a history of laparoscopic oophorectomy presented with epigastric pain, nausea, and vomiting. Contrast computed tomography revealed jejunojejunal intussusception, with no visible lead point. Spontaneous reduction was confirmed during exploratory laparoscopy. After lysis of adhesions, intraoperative peroral jejunoscopy was performed with the surgeons' assistance. Endoscopy confirmed the absence of tumor, and bowel resection was avoided. No recurrence has been observed during 24 months of follow-up. Intraoperative endoscopy may provide additional reassurance for the absence of a lead point in cases where preoperative enteroscopy cannot be performed and no lead points can be identified on imaging.
尽管成像方式有所改进,但成人肠套叠的病因性引导点可能难以诊断。此类引导点可能是恶性的,如果不切除,会导致复发或转移。我们描述了一例短暂性成人空肠-空肠套叠病例,术中使用内镜检查以确认无引导点。一名有腹腔镜卵巢切除术病史的39岁女性出现上腹部疼痛、恶心和呕吐。对比计算机断层扫描显示空肠-空肠套叠,未见明显引导点。在 exploratory laparoscopy 期间确认了自发复位。粘连松解后,在外科医生的协助下进行了术中经口空肠镜检查。内镜检查证实无肿瘤,避免了肠切除。在24个月的随访中未观察到复发。在无法进行术前肠镜检查且成像上未发现引导点的情况下,术中内镜检查可为无引导点提供额外的保证。