Nishide Ryo, Kamada Teppei, Takahashi Junji, Nakashima Keigo, Ito Eisaku, Nakaseko Yuichi, Suzuki Norihiko, Yoshida Masashi, Ohdaira Hironori, Suzuki Yutaka
Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan.
Case Rep Gastroenterol. 2023 Feb 7;17(1):76-81. doi: 10.1159/000529093. eCollection 2023 Jan-Dec.
The most common site of traditional serrated adenomas (TSA) is the area from the left colon to the rectum; however, there are few reports on TSA in the small intestine. Herein, we report a case of TSA of the ileum with intussusception that was diagnosed and successfully treated with laparoscopic bowel resection. The patient was a 29-year-old female with the chief complaint of recurrent abdominal pain and vomiting. Contrast-enhanced computed tomography showed a mass in the ileum and intussusception with the mass as the lead point. The patient was diagnosed with intussusception secondary to a small intestinal tumor. Due to the difficulty in endoscopic treatment resulting from the localization of the lesion, elective laparoscopic surgery was planned. Intra-abdominal examination revealed intussusception of the small intestine in the pelvic ileum, and an elastic soft mass 400 cm from the ligament of Treitz was identified at the lead point of intussusception. Partial laparoscopic resection of the small intestine was performed, with an operation time of 81 min, and a small amount of bleeding. The pathological diagnosis was TSA of the ileum, and the patient's postoperative course was good, with no complications. Seven months after the surgery, no recurrence of symptoms was observed. Therefore, from our case of TSA of the ileum with intussusception that was successfully treated with laparoscopic bowel resection, we conclude that when intussusception of the small intestine occurs, TSA of the ileum with malignant potential is possible, and early diagnosis by resection should be considered.
传统锯齿状腺瘤（TSA）最常见的部位是从左半结肠到直肠的区域；然而，关于小肠TSA的报道很少。在此，我们报告一例回肠TSA伴肠套叠的病例，该病例经腹腔镜肠切除诊断并成功治疗。患者为29岁女性，主要症状为反复腹痛和呕吐。增强计算机断层扫描显示回肠有一肿块，以该肿块为引导点发生肠套叠。患者被诊断为继发于小肠肿瘤的肠套叠。由于病变定位导致内镜治疗困难，计划进行择期腹腔镜手术。腹腔检查发现盆腔回肠处小肠发生肠套叠，在肠套叠的引导点处发现距Treitz韧带400 cm处有一个质地柔韧的软肿块。进行了腹腔镜下小肠部分切除术，手术时间为81分钟，出血量少。病理诊断为回肠TSA，患者术后恢复良好，无并发症。术后七个月，未观察到症状复发。因此，从我们成功通过腹腔镜肠切除治疗的回肠TSA伴肠套叠病例中，我们得出结论，当发生小肠肠套叠时，存在具有恶性潜能的回肠TSA的可能，应考虑通过切除进行早期诊断。
