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经皮内镜下胃造口术喂养管移位导致顺行性胃十二指肠套叠1例罕见病例

A Rare Case of Anterograde Gastroduodenal Intussusception Caused by Migrated Percutaneous Endoscopic Gastrostomy Feeding Tube.

作者信息

Elghezewi Abdelwahap, Hammad Mohamed, Mohamed Mujtaba, Chirico Peter, Frandah Wesam

机构信息

Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA.

Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA.

出版信息

J Med Cases. 2023 May;14(5):169-173. doi: 10.14740/jmc4101. Epub 2023 May 31.

Abstract

Gastroduodenal intussusception is a critical condition in which stomach protrudes into the duodenum. It is a very rare condition in adults. Most common causes include intra luminal lesions in the stomach including benign or malignant tumors of the stomach. Most common tumors included are gastrointestinal stromal tumors (GISTs), gastric carcinoma, gastric lipoma, gastric leiomyoma, and gastric schwannoma. It is extremely rare to be caused by migration of percutaneous feeding tube. A 50-year-old woman with a past medical history (PMH) of dysphagia status post percutaneous endoscopic gastrostomy (PEG) tube, history of spastic quadriplegia, presented with acute nausea, vomiting and abdominal distention, and was found to have gastroduodenal intussusception in computed tomography (CT) scan. Condition resolved after retracting PEG tube. Endoscopy did not reveal any intra luminal lesions. External fixation using Avanos Saf-T-Pexy T-fasteners was performed to prevent recurrence of this condition. Most common of causes of gastroduodenal intussusception are GIST tumors of stomach. CT abdomen is the most accurate test and upper endoscopy is needed to rule out any intra luminal causes. Treatment of choice is either endoscopic or surgical resection. External fixation is essential to prevent recurrence.

摘要

胃十二指肠套叠是一种严重的病症,即胃向十二指肠内突出。在成年人中这是一种非常罕见的病症。最常见的病因包括胃内的腔内病变,如胃的良性或恶性肿瘤。其中最常见的肿瘤有胃肠道间质瘤(GISTs)、胃癌、胃脂肪瘤、胃平滑肌瘤和胃神经鞘瘤。由经皮饲管移位引起的情况极为罕见。一名50岁女性,有经皮内镜下胃造口术(PEG)管置入后吞咽困难病史、痉挛性四肢瘫痪病史,出现急性恶心、呕吐和腹胀,计算机断层扫描(CT)发现有胃十二指肠套叠。在收回PEG管后病情缓解。内镜检查未发现任何腔内病变。使用阿瓦诺斯Saf-T-Pexy T型固定器进行外部固定以防止这种情况复发。胃十二指肠套叠最常见的病因是胃的GIST肿瘤。腹部CT是最准确的检查,需要进行上消化道内镜检查以排除任何腔内病因。首选治疗方法是内镜或手术切除。外部固定对于预防复发至关重要。

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