Kahveci Alp S, Mubarak Muhammad F, Perveze Isma, Daglilar Ebubekir S
School of Medicine, University of Missouri, Columbia, MO.
Department of Gastroenterology, University of Missouri, Columbia, MO.
Ochsner J. 2023 Spring;23(1):67-71. doi: 10.31486/toj.22.0035.
Asymptomatic patients at average risk of developing colorectal cancer are encouraged to undergo screening colonoscopy beginning at age 45 years. While ileal intubation is often considered the gold standard for a complete colonoscopy, the relatively low diagnostic yield has prevented widespread adoption. Small bowel cancers, including neuroendocrine tumors, may present incidentally as terminal ileitis on routine colonoscopy with terminal ileum intubation. Neuroendocrine tumors, the most common primary neoplasm of the small intestine, are often asymptomatic or present as nonspecific abdominal pain in the sixth or seventh decade of life. A 51-year-old asymptomatic male with unremarkable physical examination underwent screening colonoscopy that revealed scattered ulcerations of the terminal ileum. Immunohistochemistry of the lesion was consistent with well-differentiated neuroendocrine tumor, World Health Organization Grade I. DOTATATE positron emission tomography/computed tomography demonstrated avid adjacent right mesenteric lymph node and avid focal pancreatic body lesion. Fine-needle biopsy and immunohistochemistry of the pancreatic lesion confirmed neuroendocrine tumor, while the mesenteric lymph node was found to be benign. The patient underwent robotic-assisted ileocolic resection and has ongoing surveillance of the pancreatic lesion. Terminal ileitis encompasses a host of pathologic processes, including inflammatory states, infectious disease, malignancy, and vasculitis. Importantly, small bowel cancer is an increasing cause of terminal ileitis. Screening colonoscopy with ileal intubation can be a valuable tool for early detection of these lesions.
鼓励患结直肠癌平均风险的无症状患者从45岁开始接受筛查性结肠镜检查。虽然回肠插管常被视为全结肠镜检查的金标准，但相对较低的诊断率阻碍了其广泛应用。小肠癌，包括神经内分泌肿瘤，在常规结肠镜检查回肠末段插管时可能偶然表现为末端回肠炎。神经内分泌肿瘤是小肠最常见的原发性肿瘤，通常无症状，或在人生第六或第七个十年表现为非特异性腹痛。一名51岁无症状男性，体格检查无异常，接受了筛查性结肠镜检查，发现回肠末端有散在溃疡。病变的免疫组化结果与高分化神经内分泌肿瘤（世界卫生组织I级）一致。DOTATATE正电子发射断层扫描/计算机断层扫描显示相邻的右肠系膜淋巴结摄取增加，胰腺体部有局灶性摄取增加的病变。胰腺病变的细针穿刺活检和免疫组化证实为神经内分泌肿瘤，而肠系膜淋巴结为良性。该患者接受了机器人辅助回结肠切除术，并对胰腺病变进行持续监测。末端回肠炎包括许多病理过程，包括炎症状态、传染病、恶性肿瘤和血管炎。重要的是，小肠癌是导致末端回肠炎的一个日益常见的原因。带回肠插管的筛查性结肠镜检查可能是早期发现这些病变的一个有价值的工具。
