B型利钠肽预测妊娠合并先天性心脏病相关肺动脉高压患者心血管不良事件发生的分析

目的:分析妊娠合并先天性心脏病相关肺动脉高压(CHD-PAH)患者,早中孕期B型利钠肽(BNP),在预测妊娠合并CHD-PAH妊娠期,心血管不良事件发生是否为影响因素,同时探讨该人群在妊娠期间不良事件的结局。方法:选取2015年01月至2019年12月,首都医科大学附属北京安贞医院妇产科,收治并终止妊娠的妊娠合并CHD-PAH患者,回顾性分析BNP在预测妊娠合并CHD-PAH患者,妊娠期心血管不良事件发生的影响因素。结果:共48例CHD-PAH患者发生心脏不良事件,其中8例患者死亡。当BNP≥100 ng/L不良心血管事件发生率更高,血浆BNP50ng/L的患者心血管不良事件发生率较低,BNP≥300ng/L为预测心血管不良事件独立影响因素(OR=17.348,95%CI:4.644～64.799),同时研究还发现了重度肺动脉高压为预测心血管不良事件的因素(mPAP≥80 mmHg,1 mmHg=0.133 kPa,OR=6.329,95%CI:1.822～21.988,P0.05),并且BNP≥300 ng/L的重度肺动脉高压患者发生心血管不良事件的可能性极高。结论:CHD-PAH患者应避免妊娠,如患者拒绝终止妊娠,应在妊娠期间动态评估妊娠风险,密切、充分评估心功能,作为此类患者心血管不良事件的风险因素,BNP升高预示患者心血管不良事件发生率增加,在预测妊娠期间不良心血管事件风险方面有额外的价值。     

肾动脉狭窄与高血压病患者心房颤动的相关性探讨

目的探讨肾动脉狭窄(RAS)与高血压病患者发生心房颤动(AF)的相关性。方法回顾性分析2003年11月至2014年3月在首都医科大学附属北京安贞医院首次住院且不合并AF的632例高血压病住院患者,包括551例原发性高血压病患者(非RAS组)和81例合并有RAS(RAS组,包括20例左侧RAS、35例右侧RAS以及26例双侧RAS)的高血压病患者。观察随访所有纳入患者AF发病情况、心脏形态变化以及不良心血管事件(包括非致死性心肌梗死、卒中)发生情况。结果所有患者随访中位时间为38(12,70)个月。非RAS组患者有14例(2.5%)出现新发AF,RAS组患者有7例(8.6%)出现了新发AF(P=0.011)。logistic单因素回归分析示,血浆醛固酮(OR 24.165,95%CI 1.284～454.819,P=0.033)、RAS(OR 3.628,95%CI 1.418～9.282,P=0.007)与新发AF相关;糖尿病(OR 2.507,95%CI 1.336～4.701,P=0.004)、利尿药(OR 2.023,95%CI 1.078～3.794,P=0.028)与发生不良心血管事件相关。logistic多因素回归分析示,仅RAS(OR 3.325,95%CI 1.092～10.120,P=0.034)与新发AF相关;仅糖尿病(OR 2.495,95%CI 1.232～5.050,P=0.011)与发生不良心血管事件相关;而血浆肾素、血管紧张素Ⅱ、醛固酮水平与新发AF无相关性。单位时间内左心房内径增加与血清肌酸酐(r=–0.1628,P=0.0015,y=0.0031X–0.1709)和肾小球滤过率(r=–0.1375,P=0.0080,y=–0.0047X+0.4430)显著相关。结论 RAS与新发AF相关,但仍需进一步探讨。RAS患者AF风险增加的机制可能与血浆肾素、血管紧张素Ⅱ以及醛固酮水平无关,但可能与RAS患者肾功能不全及左心房重构有关。     

急性心肌梗死患者PCI术中血栓事件相关危险因素及转归分析

目的分析急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术中血栓事件(IPTE)的发生率、临床病变及相关危险因素等特点。探讨IPTE对于心脏结构功能及主要不良心脏事件(MACE)的影响。方法选择2013年1月至2014年12月在海南省人民医院心血管内科连续收治的确诊为AMI并在住院期间接受PCI术的836例患者为研究对象,其中男708例,平均年龄61.05±11.96岁;女128例,平均年龄68.18±10.42岁。将PCI术中出现血栓事件的患者入选IPTE组,未出现血栓事件的患者入选NIPTE组。所有入选患者行PCI术前送检血常规、血生化、凝血功能等指标。依据GRACE评分、CURSADE评分、SYNTAX积分及血栓负荷积分等进行危险分层,并应用独立样本t检验、多因素Logistic回归等方法进行分析。结果入选患者中出现IPTE 166例(19.86%),未出现IPTE 670例。IPTE组与NIPTE组SYNTAX积分无显著差异,但血栓负荷积分显著高于NIPTE组(1. 11±0. 78比0.57±0.70,P0.001)。IPTE组患者入院时首次CK-MB(127.20±138.36 U/L比89.67±139.25 U/L,P0.01)、首次TNT(2.30±3.04μg/L比1.81±2.59μg/L,P0.05)、hs-CRP(28.90±43.97 mg/L比22.96±30.92 mg/L,P0.05)、白细胞数(11.50±3.94 109/L比10.43±3.63 109/L,P=0.001)及Hcy(17. 26±15. 28μmol/L比14. 41±8. 33μmol/L,P 0.05)显著高于NIPTE组。IPTE组患者心力衰竭发生率较高(30.1%比22.2%,P0.05),两组死亡、再梗死、心源性休克、心脏骤停等事件无显著差异。多因素Logistic回归分析显示,年龄(OR=1.039,95%CI为1.017~1.062,P0.001)、血糖(OR=1.107,95%CI为1.023~1.197,P0.05)、FIB降低(OR=0.758,95%CI为0.644~0.893,P0.05)、TT缩短(OR=0.994,95%CI为0.990~0.998,P0.01)、Hcy(OR=1.033,95%CI为1.010~1.058,P0.01)、RBC(OR=2.078,95%CI为1.357~3.183,P0.01)、TNT(OR=1.144,95%CI为1.048~1.249,P0.01)以及血栓负荷积分(OR=2.773,95%CI为2.067~3.719,P0.001)是出现IPTE的独立危险因素。结论本研究中AMI患者PCI术中IPTE发生率为19.86%; IPTE组患者合并心力衰竭发生率较高;多因素Logistic回归分析显示年龄、血糖、FIB、TT、Hcy、RBC及血栓负荷积分是AMI患者PCI术中出现IPTE的独立危险因素。     

吸入和静脉麻醉对老年冠心病患者术后不良心血管事件控制的影响比较

目的探讨吸入麻醉方式和静脉麻醉方式在老年冠心病患者术后心血管不良事件控制中的效果。方法将2019年7月至2020年7月入住我院的120例老年冠心病非心脏手术患者根据随机数字表法分为吸入组(n=60)和静脉组(n=60),两组患者麻醉诱导方式均为咪达唑仑1mg+丙泊酚2.5mg/kg+舒芬太尼0.2μg/kg+罗库溴铵0.6～0.8mg/kg,吸入组患者采用七氟醚和50%氧化亚氮方式,静脉组患者采用3mg/kg/min丙泊酚+0.15μg/kg/min瑞芬太尼持续静脉泵注,比较两组患者在术后15天内不良心血管事件的发生率,分析老年冠心病患者不同麻醉方式非心脏手术术后不良心血管事件发生高危因素。结果术后15天内,吸入组发生不良心血管事件为7例(11.67%),静脉组发生不良心血管事件24例(40.00%),组间比较有统计学意义(P0.05)。单因素分析发现术中高血压、术中低血压和静脉麻醉是老年冠心病患者非心脏手术术后不良心血管事件发生的主要因素(P0.05),而年龄、性别、吸烟史等不适老年冠心病患者非心脏手术术后不良心血管事件发生的主要因素(P0.05)。多因素Logistic回归分析发现:术中高血压、术中低血压和静脉麻醉是老年冠心病患者非心脏手术术后不良心血管事件发生的独高危因素(P0.05)。结论吸入麻醉能够有效降低老年冠心病患者非心脏手术术后不良心血管事件发生的风险性,值得进行临床应用推广。     

大于等于75岁非瓣膜性心房颤动患者发生体循环栓塞相关因素分析

目的探讨≥75岁非瓣膜性心房颤动(NVAF)患者体循环栓塞(SE)的相关危险因素, 为临床中降低NVAF患者SE风险提供依据。方法病例对照研究。收集2018年10月至2020年10月于新疆医科大学第一附属医院住院的≥75岁NVAF患者, 根据NVAF后发生SE情况分为无SE组(1 127例)和SE组(433例)。应用多因素logistic回归对NVAF患者SE相关因素及未抗凝患者相关危险因素进行分析。结果多因素回归分析表明房颤病史≥5年的OR值为2.75(95%CI 1.98～3.82, P<0.01), 脂蛋白(a)>300 g/L的SE风险高于脂蛋白(a)≤300 g/L(OR=2.07, 95%CI 1.50～2.84, P<0.01), 载脂蛋白B>1.2 g/L的OR值为1.91(95%CI 1.25～2.93, P=0.003), 左心室射血分数(LVEF)30%～49%的SE风险较高(OR=2.45, 95%CI 1.63～3.69, P<0.01), 左心房内径>40 mm的OR值为1.54(95%CI 1.16～2.07, P=0....     

重症监护病房非心脏手术患者术后新发房颤危险因素

目的调查重症监护病房(ICU)非心脏手术患者术后新发房颤(POAF)的发生情况,分析其危险因素及对近期预后的影响。方法采用回顾性、病例配对的方法。在2011年1月至2013年12月期间收住ICU的非心脏手术后成年患者2586例中,筛查术后住院期间新发房颤病例。按照1∶2的比例,选择年龄、性别和手术部位相同的病例作为对照组。采用SPSS 21.0统计软件对数据进行分析。多因素logistic回归分析筛选危险因素。比较2组患者的近期结局。结果 2.7%(71/2586)出现术后新发房颤。高龄(年龄≥75岁)及胸科手术患者术后新发房颤发生率高。在术后新发房颤患者中,77.5%(55/71)出现在术后3 d以内,仅33.8%(24/71)患者有不适主诉。在配对人群中,脓毒症(OR=11.81,95%CI 1.72~81.00,P=0.012)、低钾血症(OR=19.48,95%CI 2.31~164.09,P=0.006)、术后急性充血性心力衰竭(OR=9.91,95%CI1.92~51.22,P=0.006)及新发其他类型心律失常(OR=20.32,95%CI 3.51~117.55,P=0.001)是术后新发房颤的独立危险因素。术后新发房颤伴随机械通气时间及ICU停留时间延长及住院死亡率增高。结论非心脏手术入ICU的患者中术后新发房颤发生率为2.7%,多见于高龄(≥75岁)和胸科手术患者。在病例配对人群中,脓毒症、急性充血性心力衰竭、低钾血症和新发非房颤心律失常是术后新发房颤的危险因素。新发房颤伴随预后恶化。     

大于等于75岁非瓣膜性心房颤动患者发生体循环栓塞相关因素分析北大核心CSCD

目的探讨≥75岁非瓣膜性心房颤动(NVAF)患者体循环栓塞(SE)的相关危险因素,为临床中降低NVAF患者SE风险提供依据。方法病例对照研究。收集2018年10月至2020年10月于新疆医科大学第一附属医院住院的≥75岁NVAF患者,根据NVAF后发生SE情况分为无SE组(1127例)和SE组(433例)。应用多因素logistic回归对NVAF患者SE相关因素及未抗凝患者相关危险因素进行分析。结果多因素回归分析表明房颤病史≥5年的OR值为2.75(95%CI 1.98~3.82,P<0.01),脂蛋白(a)>300 g/L的SE风险高于脂蛋白(a)≤300 g/L(OR=2.07,95%CI 1.50~2.84,P<0.01),载脂蛋白B>1.2 g/L的OR值为1.91(95%CI 1.25~2.93,P=0.003),左心室射血分数(LVEF)30%~49%的SE风险较高(OR=2.45,95%CI 1.63~3.69,P<0.01),左心房内径>40 mm的OR值为1.54(95%CI 1.16~2.07,P=0.003),CHA2DS2-VASc≥3分的OR值为15.14(95%CI 2.05~112.13,P=0.01)。载脂蛋白AI>1.6 g/L是SE的保护性因素(OR=0.28,95%CI 0.15~0.51,P<0.01)。结论房颤病史≥5年、脂蛋白(a)>300 g/L、载脂蛋白B升高、左心房内径>40 mm、LVEF 30%~49%、CHA2DS2-VASc评分、HAS-BLED评分是NVAF患者SE的独立相关危险因素。其中载脂蛋白AI>1.6 g/L与NVAF患者SE风险呈负相关。     

术前心电图检查对老年择期非心脏手术患者术后心血管并发症的预测价值

目的探讨术前常规心电图(ECG)检查对老年择期非心脏手术患者术后心血管并发症的预测价值。方法本研究为回顾性队列研究,选择2012年11月15日至2013年01月15日期间在北京大学第一医院接受择期非心脏手术的老年患者(年龄≥60岁)为研究对象。记录术前ECG检查结果、患者围术期相关资料和术后住院期间的并发症。结果本研究有784名患者进入统计分析。术前ECG异常的整体发生率为35.1%。术后心血管并发症发生率在ECG正常组与ECG异常组之间无统计学差异(3.7%vs 3.6%,P=0.946)。术前ECG异常预测术后心血管并发症的ROC曲线下面积为0.547(95%CI:0.447~0.581,P=0.351)。多因素回归分析显示女性(OR=3.164,95%CI:1.365~7.335,P=0.007)、年龄增加(OR=1.131,95%CI:1.068~1.198,P0.001)、美国麻醉医师协会(ASA)分级增高(OR=3.067,95%CI:1.394~6.750,P=0.005)、手术时间延长(OR=1.284,95%CI=1.045~1.489,P=0.014)是术后心血管并发症发生的独立危险因素。结论术前ECG检查对老年择期非心脏手术患者的术后心血管并发症预测价值有限。     

亚临床甲状腺功能减退症对经皮冠状动脉介入治疗患者临床结局的影响

目的:分析亚临床甲状腺功能减退症(SCH)对经皮冠状动脉介入治疗(PCI)患者术后临床转归的影响。方法:连续入组2012年1月至2017年12月在定安县人民医院诊断并在海南省人民医院心导管室行冠状动脉造影检查并接受PCI治疗的936例冠心病患者。根据促甲状腺激素(TSH)水平,分为甲状腺功能正常组(ET组,n=836)和亚临床甲状腺功能减退症组(SCH组,n=100);SCH组进一步分为两个亚组:SCH组1(TSH 4.5～6.9 mIU/L)和SCH组2(TSH≥7.0 mIU/L)。比较各组之间PCI后不良临床结局(包括非致命性心肌梗死、再次血运重建、心原性死亡以及上述终点的复合心血管事件)的差异,并使用多因素Cox回归分析评估SCH与不良临床结局之间的独立相关性。结果:中位随访321天(170～473天),SCH组心原性死亡(3.0%vs 1.2%,P=0.006)、非致命性心肌梗死(4.0%vs 3.1%,P=0.018)、再次血运重建(17.0%vs 16.1%,P=0.017)和复合心血管事件(20.6%vs 3.0%,P=0.002)的发生率均高于ET组。多因素Cox回归分析显示,SCH与复合心血管事件的风险独立相关(HR=1.52,95%CI:1.04～2.22,P=0.0293)。血清TSH≥7.0 mIU/L与复合心血管事件的风险显著相关(OR=2.07,95%CI:1.28～3.34,P=0.0029)。结论:SCH患者PCI术后预后较差,TSH≥7.0 mIU/L时复合心血管事件风险明显增加。     

中国非ST段抬高型心肌梗死患者住院期间死亡的危险因素分析

目的:探讨中国非ST段抬高型心肌梗死患者(NSTEMI)住院期间死亡的危险因素。方法:纳入2013-01至2014-09期间参加中国急性心肌梗死(CAMI)注册登记研究的NSTEMI患者5 816例。352例患者在住院期间死亡,为住院期死亡组,余住院期间生存的5 464例患者为住院期生存组。收集患者基线资料、实验室检查、治疗方法、院内结局等资料,以住院期间死亡为主要结局指标构建多因素Logistic回归模型,探讨NSTEMI患者住院期间死亡独立危险因素。结果:6.05%(352/5816)的NSTEMI患者在住院期间死亡,两组患者基线资料存在显著差异。多因素Logistic回归分析结果提示,年龄[每增加1岁,比值比(OR)=1.027;95%可信区间(CI):1.014~1.041;P0.01)、体重指数(每增加1kg/m~2,OR=0.943;95%CI:0.900~0.988;P0.01)、收缩压(每增加1 mmH g,OR=0.983;95%CI:0.978~0.988;P0.01)、Killip心功能分级(每增加1级,OR=1.565;95%CI:1.370~1.786;P0.01)、心跳骤停(OR=3.118;95%CI:1.339~7.262;P0.01)、ST段压低(OR=1.571;95%CI:1.169~2.110;P0.01)、新发完全性左束支传导阻滞(OR=4.579;95%CI:1.876~11.177;P0.01)、血肌酐(每增加1μmol/L,OR=1.004;95%CI:1.002~1.005;P0.01)、白细胞计数(每增加1×109/L,OR=1.100;95%CI:1.071~1.130;P0.01)、从不吸烟(OR=2.080;95%CI:1.460~2.962;P0.01)、既往心肌梗死病史(OR=1.913;95%CI:1.298~2.820;P0.01)、经皮冠状动脉介入治疗(PCI)史(OR=0.322;95%CI:0.142~0.729;P0.01)是患者住院期间死亡的独立危险因素。结论:本研究发现12个因素是NSTEMI患者住院期间死亡的独立危险因素,有助于临床医生早期识别高危患者并选择最佳诊疗策略。     

Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors – a multi-institutional study

Background

Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs.

Pylorus-preserving pancreaticoduodenectomy with combined resection of the portal vein and gastrointestinal reconstruction by imanaga procedure for ductal cancer of the head of the pancreas

Twenty-six patients who underwent pyloruspreserving pancreaticoduodenectomy (PPPD) for ductal cancer of the head of the pancreas between 1983 and 1993 were reviewed. Gastrointestinal continuity was restored by the methods of Imanaga (n=21) and Traverso (n=5). Combined resection of the portal vein and/or superior mesenteric vein was performed in 13 patients. Surgical complications occurred in 5 patients, but there were no postoperative deaths. Delayed gastric emptying was observed in 42% of patients. The median survival time for all 26 patients was 13 months. Three patients survived for more than 3 years, and one of them is currently alive without recurrence at 10 years. Differences in survival rates were not apparent between patients who underwent PPPD with and without portal vein resection. Survival rate after PPPD was compared with that after pancreaticoduodenectomy (PD) performed between 1974 and 1992; the difference was not significant. Patients who underwent noncurative PPPD had a significantly better survival rate than those who underwent noncurative PD (P<0.05). PPPD has improved the quality of life of the resected patients, without reducing survival rate. At present, PPPD by the Imanaga procedure could be the best choice for management of cancer of the pancreatic head.     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Cystic mesothelioma of the peritoneum

We report a case of cystic mesothelioma of the peritoneum (CMP), a rare tumor. The magnetic resonance imaging (MRI) findings and the histochemical features were studied. The patient was an 18-year-old woman who presented with upper abdominal pain. Abdominal ultrasonography and computed tomography showed a well defined cystic mass with a solid papillary projection in its lumen. MRI of the cyst showed high intensity on T2- and proton weighted images and low intensity on T1-weighted images, and the solid projection showed low intensity on T2- and proton-weighted images and slight low intensity on T1-weighted images, on which it was well enhanced. The lesion was suspected to be a benign cyst, such as a hemangioma, lymphangioma, or a splenic or pancreatic cyst. Complete surgical resection was performed. The resected specimen consisted of a unilocular cystic mass, with a solid projection, weighing 260g and measuring 10 cm in diameter. The final diagnosis, arrived at by histopathological examination, was low-grade malignant CMP. The tumor cells were strongly positive for keratin, weakly positive for vimentin, and negative for epithelial membranous antigen. The patient is now well and symptom-free with no recurrence 19 months after operation. CMP is a rare tumor; only 12 cases have previously been reported in Japan.     

Surgical anatomy of the pancreas for limited resection

The fusion fascia of the head of the pancreas is called the "fusion fascia of Treitz" and that of the body and tail of the pancreas is termed the "fusion fascia of Toldt". The fusion fascia is histologically composed of a loose connective tissue membrane. All of the important pancreaticoduodenal arcades of arteries and veins are situated on this membrane, i.e., between this membrane and the pancreatic parenchyma. The topography of the head of the pancreas shows that, after departing from the gastroducodenal artery, the anterior superior pancreaticoduodenal artery runs toward a point 1.5 cm below the papilla of Vater, then turns to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery. For preserving the duodenum, the artery toward the papilla is very important. The artery toward the papilla of Vater runs along the right side of the common bile duct after departing from the posterior superior pancreaticoduodenal artery. The gastrocolic trunk of Henle has been reported to be found in about 60% of individuals. It is possible that the gastroepiploic vein and anterior superior pancreaticoduodenal vein (ASPDV) can be divided at pancreaticoduodenectomy, with preservation of the superior right colic vein, if this area is free of carcinoma. The ASPDV and anterior inferior pancreaticoduodenal vein form an arcade on the anterior surface of the pancreas. However, arcade formation was not found between the posterior superior pancreaticoduodenal vein and posterior inferior pancreaticoduodenal vein in many of the individuals examined. The vein joined by the inferior mesenteric vein was also investigated.     

A Case of Endometriosis of the Appendix

A 51-year-old woman visited our clinic her chief complaint being right hypogastric discomfort. An abdominal ultrasonography revealed a circular, cystic mass in the right hypogastric region. A colorectal radiography disclosed a semi-globular shadow defect at the end of the cecum and did not visualize the appendix. A colorectal endoscopy revealed a submucosal tumor accompanied by a central dimple which seemed to represent the ostium appendicis vermiformis. Based on a preoperative diagnosis of submucosal tumor, the patient underwent a partial resection of the cecum. A histopathological examination of tissue removed led to a diagnosis of endometriosis of the appendix. In Japan, 7 cases of endometriosis of the appendix have been reported to date. In those cases, endometriosis of the appendix was detected as a lesion accompanying endometriosis of some other site or during laparotomy was based on a diagnosis of acute appendicitis. Unlike these cases, the patient presented here had been diagnosed by a preoperative colorectal radiography and endoscopy as having a submucosal tumor of the appendix.     

Adenocarcinoma arising in a tubular duplication of the jejunum

To our knowledge, only five cases of malignant changes in small-bowel duplication have been reported previously in the English-language literature, and these were found only in ileal duplications. We describe a unique case of adenocarcinoma arising in a tubular duplication of the jejunum; this is the oldest patients in whom malignant tumor of alimentary tract duplication has been reported. A 73-year-old man was admitted to our hospital because of lower abdominal pain. Computed tomography (CT) and ultrasonography showed two abdominal masses; one, about 5cm in size, was observed in the upper abdomen, the superior mesenteric artery (SMA) and the other, which was a well-demarcated heterogeneous mass, was revealed in the lower abdomen. Laparotomy revealed the mass in the upper abdomen involved the SMA and transverse colon, while the mass in the lower abdomen was of white globular form, ping-pong ball size, in the jejunal serosa approximately 40cm on the anal side from Treiz's ligament. Transverse colostomy and a partial jejunectomy were performed, and the tumor was resected. Histologically, the diagnosis was adenocarcinoma arising in a tubular duplication of the jejunum. The patient died of necrosis and perforation of the intestine due to obstruction of the SMA 7 months after the surgery. Autopsy revealed that the upper abdominal mass consisted of metastatic foci associated with the lymph node of the SMA.