大量出血を契機として診断された小腸GISTの1例 [in Japanese] A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE SMALL INTESTINE PRESENTED WITH MASSIVE BLEEDING [in Japanese]
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症例は58歳,女性.めまい・呼吸苦あり,当院を受診した.入院後下血を認めた.ヘモグロビン値7.3g/dlと著明な貧血あり,緊急上部・下部消化管内視鏡検査を施行したが出血源は同定されなかった.下血が持続し,緊急手術を施行した. Treitz靱帯から140cmの小腸に管外性に発育した4×3cmの腫瘍を認め,腫瘍を含む小腸の部分切除術を行った.術後経過は良好で退院となった.病理・免疫組織学的検索でGISTと診断された.<br> 小腸は質的診断が困難なため,消化管出血の際には小腸腫瘍の可能性を念頭に置き精査加療を行う必要があると考えられた.
A 58-year-old woman was seen at the hospital because of dizziness and dyspnea, and had massive anal bleeding after admission. Prominent anemia was noted as the hemoglobin lebel was 7.3g/dl. Emergency upper and lower gastrointestinal endoscopy failed to identify the bleeding point. Anal bleeding persisted so that an emergency operation was carried out. A 4×3cm tumor showing an extraluminal growth was present in the small intestine 140cm distal from the Treitz' ligament. Partial resection of the small intestine including the tumor was carried out. The postoperative course was uneventful and the patient was discharged from the hospital. The tumor was diagnosed as gastrointestinal stromal tumor (GIST) by pathological and immunohistoligical studies.<br>It is difficult to make the qualitative diagnosis as for small intestinal lesions. Accordingly, we must keep a possibility of a small intestinal tumor in mind for gastrointestinal bleeding, explore and treat.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(6), 1321-1324, 2006-06-25
Japan Surgical Association