Minimally Invasive Surgery for Adult Intussusception Caused by Primary Mucinous Adenocarcinoma of Jejunum: Report of a Case

微創手術治療成人小腸腺癌合併腸套疊：病例報告

陳明鎭(Ming-Jenn Chen) ； 戴運生(Yun-Sheng Tai)

《Formosan Journal of Surgery》 42卷6期 (2009/12) Pp. 329-333

https://doi.org/10.29833/FJS.200912.0005

摘要

不同於兒童腸套疊的是成人腸套疊通常由明確的病因所造成。小腸癌是其中造成成人腸套疊可能的重要原因之一。原發性小腸癌非常罕見，它的診斷及治療也是外科醫師的挑戰，儘管根除性手術之後，預後仍不佳。我們報告一位39歲男性之案例，主要症狀是噁心、嘔吐且食慾不佳，在腹部理學檢查並無腫塊。腹部超音波發現一“僞腎狀”(Pseudokidney)的病變，合併近端小腸之腫脹。腹部電腦斷層則在左腹部有－4公分大小的腫塊，合併空腸－空腸套疊。經由腹腔鏡輔助微創手術證實併切除此段小腸。最終病理報告發現爲空腸黏液腺癌。患者經過兩年追蹤，無復發之跡象。

並列摘要

Adult intussusception is an unusual cause of intestinal obstruction. In contrast to children, intussusception in adults is usually due to a definable lesion. It is not unusual for small bowel cancer to act as the lead point for adult intussuception. Primary adenocarcinoma of the small bowel is a rare malignancy that challenges surgeons in both diagnosis and treatment. The outcome is poor despite apparent curative resection. We present the case of a 39-year-old man with the chief complaint of nausea, severe vomiting and poor oral intake. No mass was palpable on physical examination. Abdominal sonography showed a pseudokidney lesion in the left pararenal region with a dilated proximal intestine. Abdominal computed tomography revealed a pedunculate heterogenous mass lesion, 4cm in size, with a target sign in the left flank area just beneath the left kidney. Small intestine intussuception (jejuno-jejunal) was suspected. Laparoscopy confirmed the diagnosis of jejuno-jejunal intussusception and segmental resection of the small bowel with anastomosis was done extracorporeally. The final diagnosis was jejunal mucinous adenocarcinoma. No recurrence or trocar metastasis was found in the 2 years of follow-up.

並列關鍵字

minimally invasive surgery ； intussusception ； mucinous adenocarcinoma ； jejunum