十二指肠球部巨大Brunner腺腺瘤1例

<正> 病例:患者男.63岁,因"阵发性上腹胀痛1年余"于2009年6月24日来我院消化科门诊就诊。患者1年前无明显诱因出现上腹部阵发性胀痛,无饥饿痛、夜间痛,无肩胛部放射痛,腹痛与进食无关,无呕血或黑便,自服抑酸剂和促胃肠动力药后无明显好转。发病来患者体质重无下降,排便无异常。查体:一般情况良好,浅表淋巴结未及肿大,血常规检查未见异常,粪便隐血试验(+)。B超检查示:肝胆胰未见异常。2009年7月2日行胃镜检查示:十二指肠球部     

Intussusception Caused by Subserosal Lipoma of the Ileum

Abstract: In this study a case of ileal subserosal lipoma with ileocolic intussusception is reported, together with a review of the literature. The patient, a 37-year-old female, was admitted with melena and abdominal pain. A complete blood cell count revealed microcytic anemia. An ultrasonography and CT scan revealed ileocolic intussusception. On colonoscopy, a tumor was seen at the site of the ileocecal valve. Subsequently, the tumor was retracted mechanically using an endoscope. An ileogram taken after retraction revealed the tumor to have been about 50 cm proximal to the ileocecal valve. In addition to the tumor, 6 cm of the ileum was resected. The tumor was 2.5 cm in diameter; the histological diagnosis was subserosal lipoma of the ileum. This is a rare case of intussusception due to an intestinal lipoma diagnosed by various visual examinations before surgery.     

Duodenal Lipoma -A Report of Two Cases Resected by Endoscopic Polypectomy-

Duodenal lipomas are rarely reported. We reported two asymptomatic pedunculated duodenal lipomas successfully resected by endoscopic polypectomy. Case 1 was a 48-year-old Chinese female who came for a physical check-up. Upper gastrointestinal series and endoscopic examination revealed a 2.0 × 1.0 cm pedunculated polyp in the posterior wall of the bulb. Case 2 was a 67-year-old female. A 1.7 times 1.0 cm olive-shaped pedunculated polyp was found by endoscopic examination during a health check-up. Both tumors were polypectomised by endoscopy and proven to be duodenal lipomas pathologically. The diagnosis of duodenal lipoma has largely been made by surgery and autopsy in the past. It may be made nowadays with abdominal computed tomography and repeated deep biopsies. Duodenal lipomas may be treated by endoscopic polypectomy if the tumor is small and pedunculated.>     

A Case of Gastric Lipoma Removed by Endoscopic Polypectomy

Abstract: A rare case of gastric lipoma removed by endoscopic polypectomy is presented herein. A 64-year-old female was found to have a polypoid lesion in the stomach on periodic X-ray examination. Endoscopy revealed a submucosal tumor located on the posterior wall of the antrum. Endoscopic ultrasonography demonstrated a homogeneous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because the likelihood of the tumor ultimately causing obstruction or prolapse into the duodenum was high, endoscopic polypectomy was performed. There were no complications. The histological examination revealed a mass of mature adipose tissue underneath the normal mucosa, which was consistent with the diagnosis made prior to polypectomy. The preferred treatment for gastric lipomas to date has been surgical excision, because the diagnosis is difficult to make prior to treatment. In the literature, only 17 cases undergoing endoscopic treatment for gastric lipomas have been reported. Endoscopic ultrasonography and computed tomography apparently facilitate preoperative diagnosis of lipomas.     

A Case of Terminal Ileum Lipoma Treated by Endoscopic Polypectomy

Abstract: This study reports on the case of a 71-year-old man who complained of repeated episodes of right lower abdominal pain. A barium enema and colonoscopy revealed a 20 times 20 times 15 mm smooth-surfaced polypoid tumor (Yamada type III) located in the terminal ileum. An endoscopy showed that the lesion had a slightly yellowish surface and the cushion sign was observed, so the tumor was considered to be an intestinal lipoma. During colonoscopy, prolapse of the tumor occurred through the orifice of Bauhin's valve and the patient simultaneously complained of right lower abdominal pain. The tumor was removed endoscopically. After a colonoscopic polypectomy, the patient's right lower abdominal pain disappeared. A pathological examination of the specimen revealed a lipoma of the terminal ileum. In general, the correct preoperative diagnosis of intestinal lipoma is difficult. Furthermore, 80% of lipomas situated at the terminal ileum are complicated by acute intussusception. We suggest that a colonoscopic polypectomy is a useful procedure for confirming the diagnosis of intestinal lipoma and for the prophylaxis of intussusception when the tumor is located in the terminal ileum.     

A Case of Minute Duodenal Carcinoma Resected by Endoscopy

Abstract: A 61-year-old man who had experienced epigastric pain for a year underwent an esophagogas. troduodenoscopy (EGD) which revealed a tiny, lobular and uneven-surfaced protrusion (approximately 4 mm in diameter), well demarcated at the base and normal in color, in the duodenal bulb. A biopsy revealed a well differentiated adenocarcinoma. After admission, an endoscopic mucosal resection was performzed for this lesion. The resected tissue was 19 ×14 mm in size and contained a carcinoma measuring 4×3 mm in diameter. Histopathologically, it was a well differentiated tubular adenocarcinoma limited to the mucosa; the lesion had been completely resected. In Japan, 133 cases of early primary duodenal carcinoma have been reported in the literature. However, the so-called minute cancer measuring less than 5 mm in diameter has never been reported before. Dzagnosis, anatomical distribution, and treatment of the reported cases of early duodenal carcinoma were analyzed in this paper.     

Submucosal Giant Lipoma of the Colon as an Unusual Cause of Partial Intestinal Occlusion: Report on Seven Consecutive Cases

Background: Colonic lipomas begin to be symptomatic when they reach a certain size, although the presentation can vary. In this study, we aimed to evaluate our experiences with the management of patients who presented with symptomatic giant colonic lipomas.MethodsThe data of 7 patients with single colonic lipoma were retrospectively reviewed. The following data were evaluated: age, gender, clinical and diagnostic findings, American Society of Anesthesiologists (ASA) score, operative findings, postoperative complications, mortality, hospital stay duration, and hospital readmission. The diagnosis of colonic lipoma was established by computed tomography (CT).Results: In this study, 4 (57.1%) of 7 patients with colonic lipoma were female, and 3 (42.9%) were male. The mean age was 56.7 years (range, 45-69). The main symptoms were abdominal pain (100%), and constipation (71.4%). The findings of intestinal occlusion detected on CT confirmed the diagnosis in all patients. Colon lipoma was located in the ascending colon in 2 patients, in the hepatic flexure in 2 patients, in the transverse colon in 2 patients, and in the cecum in 1 patient. The surgical procedure was uneventful in all patients. Four (57.1%) patients underwent laparoscopic colonic resection, while in the remaining 3 (42.9%) patients, a laparotomy was performed. The mean operating time was 185.7 min (150-210). Length of stay was 7.1 days (6-10), with no mortality. The mean diameter of the lesions was 7.4 cm (6-9). At a 6-month follow-up, all patients were asymptomatic with no signs of recurrence.ConclusionAlthough colon lipomas are rare, they are of great importance because they can be symptomatic and can be confused with colon malignancies in the differential diagnosis. Being able to make a definitive preoperative diagnosis will change the surgical strategy. A minimally invasive surgical approach should be employed to resect symptomatic colonic lipomas with an experienced surgical team in eligible patients whenever possible.     

Case Report: A Rare Case of a Giant Right Coronary Artery Aneurysm

We report the case of a 34-year-old female patient with a giant thrombus-filled aneurysm of the right coronary artery presenting as a spherical cardiac mass on echocardiography. The cardiac mass was found to be an 8-cm right coronary artery aneurysm on cardiac magnetic resonance imaging, which also revealed a 3.5-cm proximal left coronary aneurysm and a very small aneurysm at the origin of the obtuse marginal coronary artery. Due to the extent and size of the right coronary aneurysm, a decision for surgical intervention was made. Resection of the right coronary artery aneurysm with vein graft replacement and a bypass to the left anterior descending followed by subsequent exclusion of the aneurysm was successfully performed.     

An Endoscopically Resected Case of Early Carcinoma of the Duodenal Bulb

We report here on a case of early carcinoma originating in the duodenal bulb. The patient was a 70-year-old woman who complained of nausea. A gastrointestinal endoscopy disclosed a lesion protruding from the duodenal bulb and a biopsy revealed adenocarcinoma. According to the results of the endoscopy, the tumor was subpedunculated and probably confined in the mucosal layer. Based on these findings, we performed an endoscopic tumor resection. A histological examination of the resected specimen revealed a papillotubular adenocarcinoma (1.7 × 1.2 × 0.8 cm) localized in the mucosal layer. No carcinomatous lesion was left in the resected margin. No symptoms of recurrence have been noted during the last 6 months. When considering clinical pathology of the present case, we assessed 39 cases of primary early carcinoma in the duodenal bulb previously reported in the Japanese literature. We considered that our patient was the 14th in Japan with an early carcinoma of the duodenum which was completely excised via endoscopic resection. We expect that endoscopic resection of early duodenal carcinoma will be widely used in the future.     

孤立性息肉样十二指肠球部胃黏膜异位1例

病例：患者男,58岁,因“反复上腹部隐痛3月余”于2010年11月9日至我院门诊就诊。患者3个月前无明显诱因下出现腹部隐痛伴嗳气、反酸,空腹时较明娃,无恶心、呕吐．无腹胀、腹泻。症状明显时不规律服用铝碳酸镁片（商品名：达喜）,500mg bid,症状可稍缓解,近一周冈饮酒致上述症状再发．     

Gardner''s Syndrome Associated with Carcinoma of the Duodenal Bulb: Report of a Case

A 49-year-old woman with Gardner's syndrome, who underwent total proctocolectomy in 1982, was found to have a cancer of the duodenal bulb. Subsequently, resection of the stomach and duodenal bulb was performed in 1983. The surgical specimen showed an ulcerating tumor in the duodenal bulb which was a moderately differentiated adenocarcinoma histologically. Multiple adenomas were present in the gastric antrum and the duodenum. Duodenal cancer so far reported has been mostly confined to the periampullary region, and cancer of the duodenal bulb associated with familial polyposis coli has not been reported.     

原发性十二指肠球部溃疡型腺癌1例并文献复习

<正> 病例:患者男,74岁,因"反复黑便半年,再发5 d"于2009年1月2日入院。患者半年前无明显诱因下解柏油样稀便共3～4次,大便潜血试验阳性,伴头晕、乏力、心悸,无发热,无腹痛。至本院行胃镜检查示十二指肠球部后壁溃疡,大小约1.2 cm×1.5 cm,胃窦部活检示幽门螺杆菌(H.pylori)(+)。予泮托拉唑40 mg bid对症治疗2周,未予以H.pylori根除治疗(具体原因不详),症状完全缓解。出院后继续予泮托拉唑40 mg qd维持治疗8周。2个月前,患者欲了解溃疡愈合情况,遂于本院复查胃镜示球部溃疡未愈合,大小与第一次胃镜所见相同,胃窦部活检示H.pylori(+)。予泮托拉     

Case Report: Giant choledochal cyst

We report an adult female with a rare giant choledochal cyst. The patient presented following a normal pregnancy with the classical triad of an abdominal mass associated with jaundice and right upper quadrant abdominal pain. The cyst was excised using an intramural technique and biliary reconstruction achieved with a Roux-en-Y hepaticojejunostomy. Our patient has remained well with no evidence of malignancy over a 12 year review period. The aetiology and current management of this condition are discussed.     

Case Report: Incidental Finding of a Giant Cardiac Mass

Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and another coronary artery, major vessel, or cardiac chamber. Prevalence of CAF is reportedly 1% to 2% in patients who undergo coronary angiography.1 One of the most common complications of CAF is formation of a coronary artery aneurysm (CAA). A study conducted by Said and colleagues in 1995 found that CAA formation was present in 26% of patients who had proven CAF by way of angiography.2 Although a precise definition of the term “giant” CAA is still lacking, it generally refers to a dilatation that exceeds the reference vessel diameter by four times.3 We report an interesting case of a 38-year-old patient who was incidentally found to have a presumed large right ventricular aneurysm, which after an open-heart surgery was identified as a CAF with formation of an unruptured giant CAA.     

A Case of Giant Gastric Folds with Hypoalbuminemia Healed by Helicobacter pylori Eradication

A 66-year-old man with hypoalbuminemia was found to have diffuse giant mucosal folds in the body of the stomach. Helicobacter pylori (H pylori) status was evaluated by several examinations, all of which showed positive results. To eradicate H pylori, he was treated with clarithromycin (200mg b. i. d.), lansoprazole (30mg q. d.) and plaunotol (80mg t. i. d.). By two weeks, the serum albumin concentration had risen to 3.4g per dl. Four weeks after finishing clarithromycin therapy, endoscopy was repeated and H pylori status was evaluated as before. All examinations showed negative results and the giant mucosal folds had improved markedly. Before treatment, histological specimens showed irregular elongation of pits with inflammatory infiltrates. After treatment, the architecture of pits returned to its normal form with decreased inflammatory infiltrates. In this case, giant gastric folds and hypoalbuminemia were improved by H pylori eradication, suggesting that H pylori infection may play a role in the giant gastric folds associated with hypoalbuminemia.