Nincheri Kunz M, Evaristi L, Spadoni R, Cozzani R, Valle O, Bacigalupo B
Divisione di Chirurgia Generale, Ospedale Sant'Andrea, La Spezia.
Minerva Chir. 1994 Sep;49(9):859-65.
Lipoma is a benign tumour of mesenchymal origin which is not frequently localized in the gastroenteric tract; in anatomopathological statistics it is less rare: this is due to the fact that it rarely reaches dimensions which warrant surgical treatment. It is usually either an occasional finding during the course of laparotomy due to other motives or is the cause of complications, as in the present case of intestinal occlusion due to ileocolic invagination, resulting in emergency surgery. As a cause of occlusion tumours of the small bowel are second in terms of incidence to adhesive factors, volvuli and hernias. Invaginations account for 2/3 of small bowel occlusions caused by up to 80% of tumours: the lipoma is the most frequent benign tumour to cause invagination in its submucous polypoid and more or less scissile form. Symptoms are not specific and this causes a delay in diagnosis. Patients are often young subjects with a history of recurrent abdominal colic and sensitivity to anti-spastic drugs so much so that in the past they were diagnosed as "chronic colic" sufferers. Sometimes the only symptom is dyspepsia, or nausea and vomiting, or occasionally abdominal distension with constipation or attacks of diarrhoea. Radiology is not of great value in the diagnosis except for indicating the possible need for emergency surgery. There are no radiological tests, with or without contrast mediums, echography, CAT or MNR which can diagnose this pathology. The decision to operate is usually triggered by the presence of a complication, but perioperative extemporary histological tests are advisable for a correct surgical approach: if the form is scissile, segmentary resection of the small bowel is necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
脂肪瘤是一种间叶组织来源的良性肿瘤,很少发生于胃肠道;在解剖病理学统计中,它并非十分罕见:这是因为它很少长到需要手术治疗的大小。它通常是在因其他原因进行剖腹手术过程中偶然发现的,或者是并发症的原因,就像本例因回结肠套叠导致肠梗阻,从而需要进行急诊手术。作为肠梗阻的原因,小肠肿瘤在发病率上仅次于粘连因素、肠扭转和疝气。套叠占由肿瘤引起的小肠梗阻的三分之二,其中高达80%是由肿瘤导致的:脂肪瘤是以黏膜下息肉样且或多或少可切断的形式导致套叠的最常见良性肿瘤。症状不具有特异性,这导致诊断延迟。患者通常是年轻人群,有反复腹部绞痛病史且对解痉药物敏感,以至于过去他们被诊断为“慢性绞痛”患者。有时唯一的症状是消化不良、恶心呕吐,或者偶尔是腹胀伴便秘或腹泻发作。除了表明可能需要急诊手术外,放射学在诊断中价值不大。没有任何有或无造影剂的放射学检查、超声检查、CT或磁共振成像能够诊断这种病理情况。手术决定通常由并发症的出现引发,但为了正确的手术方式,术中临时组织学检查是可取的:如果肿瘤形态可切断,则需要对小肠进行节段性切除。(摘要截断于250字)