Piemonte F, D'Avino V, Barone G, Di Marzo S, Rizzo G M, Costanzo G, Mercogliano A, De Simone G
Regione Campania USL n. 29, Ospedale Cav. K Apicella, Reparto di Osservazione e Pronto Soccorso Chirurgico.
Minerva Chir. 1996 Nov;51(11):989-91.
The authors underline that, although rarely found, leiomyomas of the gastrointestinal tract are the most frequent benign tumours of the small intestine. On occasions, from being a simple autoptic finding or diagnosed during the course of explorative laparotomy, they may be responsible for emergency abdominal surgery, hemorrhage, occlusion or perforation. The authors discuss the experience acquired in two cases-treated during the last two years, both of which were symptomatic. In one case there was a palpable abdominal mass, and in both the key symptom was the appearance of melena a few days before being admitted to hospital. The most striking problem of this rare pathology is its diagnosis owing to both the absence of a specific clinical symptoms, and the difficulties shown in radiological diagnostics of the small intestine. In the authors' experience CAT using a contrast medium is an important instrument, whereas clyster of the small intestine is of scarce value. Explorative laparotomy was essential for removing any doubts regarding diagnosis. Both patients underwent extensive intestinal resection, including the mass and relative mesenteric wedge, with TT single-layer anastomosis. The postoperative period was normal.
作者强调,胃肠道平滑肌瘤虽罕见,但却是小肠最常见的良性肿瘤。有时,它们起初只是尸检时的一个简单发现,或在剖腹探查术中被诊断出来,却可能导致急诊腹部手术、出血、梗阻或穿孔。作者讨论了过去两年中治疗的两例有症状病例的经验。其中一例可触及腹部肿块,两例的关键症状都是入院前几天出现黑便。这种罕见病理最突出的问题是诊断困难,这是由于既没有特定的临床症状,小肠的放射学诊断也存在困难。根据作者的经验,使用造影剂的计算机断层扫描(CAT)是一项重要手段,而小肠灌肠的价值不大。剖腹探查术对于消除诊断疑虑至关重要。两名患者均接受了广泛的肠切除术,包括肿块及相关肠系膜楔形切除,并采用端端单层吻合术。术后恢复正常。