- 期刊
橫結腸放線菌感染與早期胃癌被誤診為胃癌大腸轉移―一例報告
Actinomycosis of Transverse Colon and Early Gastric Cancer Misdiagnosed as Advanced Gastric Cancer with Metastasis to the Colon-Report of a Case
摘要
本文報告1例臨床上罕見的橫行結腸放線菌感染。患者係47歲女性，主訴下腹痛及服脹，大便習性改變，大約已兩個月。大腸鋇劑攝影顯示橫行結腸有一段變窄且黏膜呈現不規則。上消化道內視鏡檢查，顯示胃角前壁有一潰瘍，經病理生檢結果為慢性潰瘍。惟臨床上仍懷疑是「進行性胃癌合併橫行結腸轉移」，故進行剖腹探查。開刀中冷凍切片顯示胃潰瘍確是胃癌組織，但很意外地，橫行結腸卻發現是放線菌感染所造成的肉芽腫。放線茵是一種厭氧性，革蘭氏陽性細菌，它存在於正常人體之口腔、扁桃腺、胃腸道及呼吸道中，以共生的方式存在。它可能在手術，穿孔或異物穿透後，感染腸道壁而形成肉芽腫。它在術前常被誤診為惡性腫瘤或腸結核。此外，本病人曾連續使用子宮內避孕器達18年，子宮內避孕器的使用與放線菌感染有密切關係，國外文獻已有甚多的報告，本文亦將討論本病例之放線菌感染是否與子宮避孕器有關。
並列摘要
A 47-year-old female housewife presented with lower abdominal pain and fullness for about one month. A change of bowel habit was noted, but she denied body weight loss. Barium enema studies of the colon revealed a constant narrowing with irregularity of mucosa in the mid-portion of the transverse colon. Colonofiberscopy was attempted but failed, because the lumen of the transverse colon was too narrow to pass the scope through it. Upper GI tract panendoscopy demonstated a malignant-looking gastric ulcer near the anterior wall of the angle. Biopsy revealed a chronic gastric ulcer only. Because gastric carcioma with extension to the transverse colon was highly suspected clinically, she received laparotomy. Frozen section biopsies of gastric ulcer and transverse colon were performed during operation. The gastric ulcer was proved to be malignant with signet-ring cells, and unexpectedly, actinomycosis was found in the transverse colon. Nearly total gastrectomy with gastroduodenostomy and segmental resection of the transverse colon with end to end anastomosis were then performed. Early gastric carcinoma was reported after serial examinations of the resected stomach. All of the resected regional lymph nodes were negative for cancerous metastasis. The pathology of the resected colon segment revealed a mucosa defect with colonies of actinomyces scattering from the mucosa to the serosa later. There was no foreign body or diverticulum formation in the colon. Actinomycosis of GI tract is rather rare and therefore usually misdiagnosed as tuberculosis or malignancy before operation. Because actinomycosis is a curable disease with present antibiotics (such as penicillin, streptomycin, tetracyclin, cleocin, etc.), the differentiation among this interestingly rare entity, carcinoma and tuberculosis in the GI tract is mandatory. The possible pathogenesis of Actionmycosis of the colon in this case is also discussed.