Diagnosis of Lipoma-Induced Ileal Intususception by Double Balloon Enteroscopy: Report of a Case

雖然小腸腫瘤的盛行率相對較低，但是曾有報告描述迴腸脂防瘤是腸套疊的原因之一。本文報告一個79歲的男性病人因下腹痛住進林口長庚醫院。平面腹X光顯示有小腸的腸阻塞。小腸攝影顯示部分腸阻塞。此外，在遠端空腸有病灶，但是無法區分病灶是在小腸管腔內或是在管腔外。經靜脈注射顯影劑後做的電腦斷層攝影確認似乎在迴腸有小腸腸套疊，誘導病灶不明。之後施行雙氣囊小腸鏡經由直接的內視鏡觀察來診斷。發現一個4公分有脂肪狀外層的黏膜下腫瘤。因為腫瘤尺寸太大，所以沒有嘗試內視鏡切除，而用染劑做了標記以方便日後的手術處置。之後病人順利接受腹腔鏡手術治療，也經由病理組織確認了脂防瘤的診斷。據我們的了解，這是第一個經由雙氣囊小腸鏡所做的手術前診斷的報告。

關鍵字

迴腸脂肪瘤；腸套疊；雙氣囊小腸鏡術

並列摘要

Small intestinal tumors are rare, while ileal lipoma-induced intussusception is even more uncommon. This report is on a 79-year-old male admitted to Chang Gung Memorial Hospital for hypogastric pain. Plain abdominal radiography demonstrated a small intestinal ileus. A small bowel series revealed partial obstruction. A mass like lesion was also noted at the distal jejunum, but it's hard to determine whether it is an intra-luminal or an extra-luminal lesion. Computed tomography with an intravenous contrast medium identified small bowel intussusception at the ileal level; the leading point seemed to be a mass with fat component. Double balloon enteroscopy (DBE) was performed for definite diagnosis via a direct view. A four centimeter sub-mucosal tumor with a fat-like yellowish tint was detected. Due to the tumor's bulk, endoscopic resection was not attempted. Instead, a tattooing with India ink was done to facilitate the subsequent surgery. And laparoscopic surgery underwent smoothly. Lipoma was confirmed histologically. To our knowledge, this is the first report of preoperative DBE diagnosis of lipoma-induced ileal intussusception.

並列關鍵字

ileal lipoma ； intussusception ； double balloon enteroscopy

國際替代計量

Diagnosis of Lipoma-Induced Ileal Intususception by Double Balloon Enteroscopy: Report of a Case

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