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西澳大利亚偏远医院诊治成人回肠-回盲部脂肪瘤性肠套叠

Adult ileocaecal intussusception caused by lipoma managed in a remote Western Australian hospital.

机构信息

Intensive Care, Bunbury Hospital, Bunbury, Australia

Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.

出版信息

BMJ Case Rep. 2024 Aug 29;17(8):e259963. doi: 10.1136/bcr-2024-259963.

Abstract

Intussusception is rare in adults, making it a challenging and often delayed diagnosis. Patients may re-present with non-specific and subacute abdominal symptoms. Abdominal CT is the most sensitive imaging modality and is often required to make the diagnosis of intussusception. In contrast to the paediatric population, intussusception in adults is most often associated with a pathological lesion acting as a lead point. In adults, the lead point is often secondary to malignancy, though benign lesions can also be implicated. As such, surgical management with selective resection is the mainstay of treatment in adults. We describe a rare case of ileocaecal intussusception in an adult secondary to a large ileocaecal lipoma, successfully treated with laparotomy and resection in a remote Western Australian hospital. The increasing availability of CT imaging and skilled general surgeons in rural and remote Australia allows for the diagnosis and surgical management of such cases without inter-hospital transfer.

摘要

成人肠套叠很少见,因此诊断具有挑战性,且往往会被延误。患者可能会出现非特异性和亚急性腹部症状。腹部 CT 是最敏感的成像方式,通常需要该检查来诊断肠套叠。与儿科人群不同,成人肠套叠最常与作为牵引点的病理性病变有关。在成人中,牵引点通常继发于恶性肿瘤,尽管良性病变也可能涉及。因此,选择性切除的手术治疗是成人肠套叠的主要治疗方法。我们描述了一例罕见的成人回盲肠肠套叠病例,继发于回盲肠巨大脂肪瘤,在西澳大利亚偏远地区的一家医院通过剖腹手术和切除成功治疗。随着 CT 成像的普及以及农村和偏远地区熟练的普通外科医生的增加,无需医院间转移即可对这些病例进行诊断和手术治疗。

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