Frosio Fabio, Rausa Emanuele, Marra Paolo, Boutron-Ruault Marie-Christine, Lucianetti Alessandro
Department of General Surgery, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy.
Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy.
World J Clin Cases. 2022 Jul 6;10(19):6710-6715. doi: 10.12998/wjcc.v10.i19.6710.
Enteric-coated medications are supposed to pass intact through the gastric environment and to release the drug content into the small intestine or the colon. Before dissolution of the enteric coating, they may appear hyperdense on computed tomography (CT). Unfortunately, few reports have been published on this topic so far. In this case report, the hyperdense appearance on contrast-enhanced CT of an enteric-coated mesalamine tablet was initially misinterpreted as a jejunal gastrointestinal stromal tumor (GIST).
An asymptomatic 81-year-old male patient, who had undergone laparoscopic right nephrectomy four years earlier for stage 1 renal carcinoma, was diagnosed with a jejunal GIST at the 4-year follow-up thoraco-abdominal CT scan. He was referred to our hub hospital for gastroenterological evaluation, and subsequently underwent 18-fluorodeoxyglucose positron emission tomography, abdominal magnetic resonance imaging, and video capsule endoscopy. None of these examinations detected any lesion of the small intestine. After reviewing all the CT images in a multidisciplinary setting, the panel estimated that the hyperdense jejunal image was consistent with a tablet rather than a GIST. The tablet was an 800 mg delayed-release enteric-coated oral mesalamine tablet (Asacol), which had been prescribed for non-specific colitis, while not informing the hospital physicians.
Delayed-release oral mesalamine (Asacol), like other enteric-coated medications, can appear as a hyperdense image on a CT scan, mimicking a small intestinal GIST. Therefore, a detailed knowledge of the patients' medications and a multidisciplinary review of the images are essential.
肠溶包衣药物理应完整通过胃部环境，并将药物成分释放至小肠或结肠。在肠溶包衣溶解之前，它们在计算机断层扫描（CT）上可能呈现高密度。遗憾的是，迄今为止关于该主题的报道甚少。在本病例报告中，一种肠溶包衣美沙拉嗪片剂在增强CT上的高密度表现最初被误诊为空肠胃肠道间质瘤（GIST）。
一名无症状的81岁男性患者，四年前因I期肾癌接受了腹腔镜右肾切除术，在4年随访的胸腹部CT扫描中被诊断为空肠胃肠道间质瘤。他被转诊至我们的中心医院进行胃肠病学评估，随后接受了18氟脱氧葡萄糖正电子发射断层扫描、腹部磁共振成像和视频胶囊内镜检查。这些检查均未发现小肠有任何病变。在多学科环境下复查所有CT图像后，专家组估计空肠高密度影像与一片片剂相符，而非胃肠道间质瘤。该片剂为800毫克缓释肠溶包衣口服美沙拉嗪片（艾迪莎），是为非特异性结肠炎所开，但未告知医院医生。
与其他肠溶包衣药物一样，缓释口服美沙拉嗪（艾迪莎）在CT扫描上可呈现高密度影像，酷似小肠胃肠道间质瘤。因此，详细了解患者用药情况并对图像进行多学科复查至关重要。
