Ramai Daryl, Qatomah Abdulrahman, Ryou Marvin, Thompson Christopher C, Aihara Hiroyuki
Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
VideoGIE. 2025 Apr 6;10(8):415-418. doi: 10.1016/j.vgie.2025.03.036. eCollection 2025 Aug.
Although isolated hamartomas are rare, they can cause bleeding that is refractory to medical treatment. Management strategies depend on factors such as tumor location, size, and bleeding intensity.
A 94-year-old woman experienced melena and a significant decrease in hemoglobin from 13 g/dL to 7 g/dL. An EGD revealed a large, bleeding pedunculated tumor in the duodenum. Previous interventions, including epinephrine injection and EMR, failed, necessitating multiple blood transfusions. After multidisciplinary consultation, endoscopic submucosal dissection was undertaken.
En bloc resection of the duodenal lesion was performed successfully. The specimen was segmented and removed without causing any trauma to the duodenal wall.
Hamartomas in the upper GI tract, particularly in the stomach or duodenum, pose a greater bleeding risk. Endoscopic submucosal dissection effectively removes large duodenal tumors, especially when EMR is unfeasible. Segmenting the specimen during retrieval minimizes trauma to surrounding tissue, preserving duodenal integrity.
尽管孤立性错构瘤罕见，但可导致药物治疗难以控制的出血。治疗策略取决于肿瘤位置、大小和出血强度等因素。
一名94岁女性出现黑便，血红蛋白从13g/dL显著降至7g/dL。胃镜检查发现十二指肠有一个带蒂的大的出血性肿瘤。先前的干预措施，包括肾上腺素注射和内镜下黏膜切除术均失败，需要多次输血。经过多学科会诊后，进行了内镜黏膜下剥离术。
成功地整块切除了十二指肠病变。标本被分段取出，未对十二指肠壁造成任何创伤。
上消化道错构瘤，尤其是胃或十二指肠的错构瘤，出血风险更大。内镜黏膜下剥离术可有效切除十二指肠大肿瘤，尤其是在内镜下黏膜切除术不可行时。取出标本时进行分段可将对周围组织的创伤降至最低，保持十二指肠的完整性。
