經由双氣囊小腸鏡診斷脂肪瘤導致出血以及間歇性空腸腸套疊－－病例報告

Jejunal Lipoma with Intestinal Bleeding and Intermittent Intussusception Diagnosed by Double Balloon Enteroscopy

胃腸道脂肪瘤是罕見的疾病，空腸脂肪瘤發生腸套疊合併出血則更少見。本文報告一位84歲男性，有2年以上偶發腹部不適的病史；在住院三天前出現嚴重的上腹痛及黑便的症狀。腹部超音波只顯示腸脹氣。小腸鋇劑攝影發現前端空腸有阻塞疑似腫瘤引起；經靜脈注射顯影劑之後做64切斷層攝影，發現空腸有個脂肪性腫瘤，合併腸套疊。双氣囊小腸鏡發現空腸內五公分大小的黏膜下腫瘤，其處黏膜略帶有黃色，並呈局部潰瘍帶有血絲。在疑似空腸結膜下脂肪瘤引起腸套疊，病人接受腹腔鏡切除手術。術後病人恢復良好，追蹤三個月而無任何併發症。

Intussusception with concomitant bleeding is an uncommon manifestation of the gastrointestinal lipoma that is clinically very rare. We reported a case of proximal jejunal lipoma in an 84-year-old male patient with intermittent abdominal vagne pain for more than 2 years and developed tarry stool for 3 days before admission. Real-time ultrasonography (RTUS) showed ouly sma1l bowel distension. A small bowel barium study soon after admission demonstrated a mass-Iike lesion in the proximal jejunum with partial obstruction. The mass had a fatty density on abdominal 64 multidetector computed tomography (64MDCT). A double ba1loon enteroscopy (DBE) then depicted a big submucosal tumor with a blood-coated ulcerative crave in the proximal jejunum. With the suspicion of submucosal jejunal lipoma inducing jejunojejunal intussusception, the patient underwent segmentaI jejunal resection through laparoscopic surgery. The postoperative course remained uneventful at three months follow-up.