Park Jun Gi, Suh Jeong Ill, Kim Yeo Un
Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 38067, South Korea.
World J Clin Cases. 2022 May 26;10(15):5012-5017. doi: 10.12998/wjcc.v10.i15.5012.
Recently reported cases of pyogenic liver abscess associated with colonic cancer in the absence of underlying disease, have included a small number of cases of gastric heterotopia (GHT). GHT is a congenital anomaly composed of ectopic gastric mucosa and can occur anywhere in the gastrointestinal tract but is more frequently encountered in the cervical esophagus. However, it is rarely observed in colon. Furthermore, most reported cases of GHT of the colon involved the rectum, and GHT involving the colon proximal to the rectum is rare.
An 83-year-old male patient presented with fever and a diagnosis of pyogenic liver abscess. Colonoscopy was performed for colon cancer workup and revealed a 1.0 cm sized polyp at the transverse colon. The polyp was removed by endoscopic mucosal resection by monopolar electrocauterization using a snare. Pathological examination revealed GHT. After administering intravenous antibiotics, the patient recovered well.
GHT in the colon could affect the development of pyogenic liver abscess by enabling hematogenous propagation of Klebsiella pneumoniae through mucosal damage. However, more study is needed due to the lack of cases.
最近报道了一些在无基础疾病情况下与结肠癌相关的化脓性肝脓肿病例,其中包括少数胃异位(GHT)病例。GHT是一种由异位胃黏膜组成的先天性异常,可发生在胃肠道的任何部位,但更常见于颈段食管。然而,在结肠中很少观察到。此外,大多数报道的结肠GHT病例累及直肠,累及直肠近端结肠的GHT很少见。
一名83岁男性患者因发热就诊,诊断为化脓性肝脓肿。为排查结肠癌进行了结肠镜检查,结果显示横结肠有一个1.0厘米大小的息肉。使用圈套器通过单极电凝进行内镜黏膜切除术切除了息肉。病理检查显示为GHT。静脉注射抗生素后,患者恢复良好。
结肠中的GHT可通过使肺炎克雷伯菌通过黏膜损伤进行血行播散,从而影响化脓性肝脓肿的发生发展。然而,由于病例数量不足,还需要更多研究。