 Case Discussion
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The 25-year-old woman had tarry stools and normal findings
on panendoscopy three months previously. She had periumbilical
abdominal pain and recurrent tarry stools for two days before
this admission.
Physical examination revealed a
pale face, anemic conjunctiva and periumbilical tenderness of
the abdomen. Rectodigital examination showed tarry stools. Her
blood pressure was 100/70 mmHg in the supine position and
pulse 80/min and regular. Her hemoglobin level was 6.6 g/dL.
Serum biochemistry examinations were within normal ranges. An
emergent panendoscopy was performed and no upper
gastrointestinal bleeding was found. Plain abdominal
roentgenography showed a dilated segment of the small
intestine. Small bowel series examination demonstrated a
dilated ileum with a tubular filling defect (Fig
1). Abdominal computed tomography showed a picture of
target lesion (Fig
2). Surgical exploration was performed due to abdominal
mass and tarry stool passage and we found an ileal mass about
2x2x3.5 cm as a leading point inducing intussusception, 110 cm
from the ileocecal valve (Fig
3,4).Histopathological
examination is shown as Fig
5 -A, B
. The postoperative course was uneventful,
and she has been symptom-free since that time.
病案分析
病人為一25歲年輕女性,因再次之消化道出血住院.由一系列之影像學檢查發現有小腸病灶,
後經手術剖腹探查証實為一先天性異常造成之成人腸套疊的特殊病例.
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 繼續教育考題
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1.
(D) |
下列有關小腸腫瘤之敘述,
何者錯誤? |
| A | 佔消化道腫瘤的1.5%~6%. |
| B | 小腸良性腫瘤較常見的有leiomyoma,
adenomatous polyp及lipoma. |
| C | 小腸惡性腫瘤較常見的有adenocarcinoma,
leiomyosarcinoma及carcinoid tumor. |
| D | Adenocarcinoma最常發生於迴腸 |
| E | Lipoma最常發生於迴腸 |
2.
(E) |
典型的成人腸套疊病例在影像學上可見: |
| A | Plain film下25%可未見任何異常 |
| B | Barium study可見” coil sparing”
appearance |
| C | Ultrasound 下橫切面可見”bull's eye
sign”, 縱切面下可見”pseudokidney sign”. |
| D | Abdominal CT 下可見” multiple
concentric rings” |
| E | 以上皆是 |
3.
(A) |
成人腸套疊的發生比例大約占所有腸套疊的: |
| A | 5% |
| B | 25% |
| C | 50% |
| D | 75% |
| E | 95% |
4.
(B) |
有關成人腸套疊的敘述,何者錯誤? |
| A | 大腸腸套疊之原發病灶以惡性腫瘤居多 |
| B | 小腸腸套疊之原發病灶以惡性腫瘤居多 |
| C | 成人腸套疊的好發部位以ileocecum附近最多 |
| D | 小腸腸套疊的治療方式大多以單純手術切除,較少須配合化學治療. |
| E | 大多需行剖腹探查 |
5.
(D) |
有關成人的腸胃道出血,下列何者的發生比例最少見? |
| A | 消化性潰瘍 |
| B | 食道靜脈瘤 |
| C | 小腸惡性腫瘤 |
| D | 小腸腸套疊 |
| E | 大腸癌 |
6.
(E) |
腹部電腦斷層下所見的Target
lesions可能為下列何者? |
| A | Appendicitis |
| B | Intussusception |
| C | Leiomyoma |
| D | Malignant melanoma |
| E | 以上皆是 |
7.
(B) |
圖五中,病理最後的診斷應來自於何種器官: |
| A | 肝臟 |
| B | 胰臟 |
| C | 淋巴組織 |
| D | 脂肪組織 |
| E | 子宮 |
8.
(B) |
承上題,此種病灶最常分佈於消化道中之何段腸道? |
| A | 食道 |
| B | 胃 |
| C | 十二指腸 |
| D | 空腸 |
| E | 迴腸 |
9.
(E) |
反覆性的消化道出血,須考慮下列何者情況? |
| A | 未診斷出的消化道腫瘤出血 |
| B | Aortoenteric fistula |
| C | Diverticulum |
| D | Angiodysplasia |
| E | 以上皆是 |
10.
(B) |
本病患的迴腸出血病灶,
最可能是以下那種原因? |
| A | 腸套疊牽扯所引起之血管出血 |
| B | 良性腫瘤本身的erosions出血 |
| C | 轉移腫瘤引起小腸的出血 |
| D | 無法得知出血的原因 |
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答案解說:
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(D)
小腸腫瘤的惡性腫瘤以adenocarcinoma 最常見, 它最好發於＋二指腸.
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(E) 以上皆是
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(A) 5%
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(B)
小腸腸套疊之原發病灶以良性腫瘤居多
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(D) The incidence of adult
intussusception is about 2-3/1,000,000 per year. Small
bowel intussusception was benign in 63% of 1,048 cases
of one meta-analysis. The incidence of small bowel
tumor is about 1/100,000 per year and about 1/5 of
them are malignant (the incidence of adult
intussusception ~ small bowel malignancy). But
bleeding rate: malignancy > benign lesion.
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(E) 以上皆是
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(B) Fig 5B, histological
findings show an aberrant pancreas with normal
pancreatic acini and ducts (original magnification x
10).
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(B) Geoffray's series of
528 patients showed aberrant pancreas occurred in the
stomach (56.7%), duodenum (27.7%), jejunum (9.7%),
Meckel’s diverticulum (4.3%) and ileum 0.2%. In:
Bruneton JN: Imaging of gastrointestinal tract
tumor.1st ed. Berlin: Springer-Verlag, 1990:
68-72.
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(E) 以上皆是
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(B) Fig 5A,
microscopically, necrosis and hemorrhage (arrows) were
found on the surface of the mass (original
magnification x
5). | | |
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