Intercostal Nerve Neurilemoma Presenting with Epigastralgia: Report of a Case

上腹區的疼痛或不適病因通常來自腸胃道；其它因素還包括：糖尿病、新陳代謝障礙、缺血性心臟病、腸道絞痛和惡性腫瘤。因週邊神經鞘瘤而引起上腹疼痛則非常少見。我們報告一位42歲男性病人，主訴持續性上腹疼痛已經好幾年，雖然經過多次的求醫，症狀仍沒有改善；最近他在左側胸壁摸到一個腫瘤，於是到門診求診。腦斷層掃描發現在左邊的第十一根肋骨旁有一個腫瘤，於是施行手術切除。病理診斷為神經鞘瘤，術後上腹疼痛的症狀完全消失。這個病例提醒我們，除了來自腸胃道的病因造成上腹的不適外，其它比較少見的病因也必須列入鑑別診斷；尤於臨床上及內視鏡一直找不出有結論時必須提高警覺。

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並列摘要

Pain or discomfort in the epigastric region is often of gastrointestinal origin. Other common causes of epigastric pain include diabetes mellitus, metabolic disturbances, ischemic heart disease, intestinal angina and malignancies. Peripheral nerve neurilemoma is an unusual cause of epigastric discomfort. We present a case of a 42-year-old man complaining of persistent epigastralgia for a number of years. The discomfort remained unresolved after numerous visits to the doctors. He presented to the outpatient department with a recent finding of a mass along the left chest wall. CT revealed a soft tissue tumor on the lateral aspect of the left elevnth rib. Surgical resection was done and the pathology confirmed the diagnosis of neurilemoma. After surgical resection there was complete resolution of the epigastralgia. This case reminds us that apart from the usual gastrointestinal causes of epigastric discomfort, we should be alert for other unusal causes of epigastralgia, especially if clinical and endoscopic findings are persistently inconclusive.

並列關鍵字

intercostal nerve neurilemoma ； schwannoma ； epigastralgia

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Intercostal Nerve Neurilemoma Presenting with Epigastralgia: Report of a Case

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