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Dapsone-Induced Granulomatous Cholestatic Hepatitis Unmasked by Steroid Taper: A Case Report 类固醇减量掩盖了多潘松诱发的肉芽肿性胆汁淤积性肝炎:病例报告
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-11 DOI: 10.1159/000534818
Shahana Prakash, Matthew Gosse, Tomohiro Tanaka
Abstract Introduction Dapsone is known to cause drug-induced liver injury (DILI) but can rarely induce the formation of hepatic granulomas. We describe a patient with jaundice who demonstrated granulomas on liver biopsy in response to dapsone. Her symptoms were only evident once steroids, used to also treat her pyoderma gangrenosum, had been tapered. Case Presentation In this case, a 67-year-old female was hospitalized due to 1 day of jaundice. She had started dapsone and prednisone concurrently 7 weeks ago to treat her pyoderma gangrenosum. Steroids were discontinued 4 days prior to symptoms. Her laboratories were notable for newly elevated alkaline phosphatase (756 U/L), aspartate transaminase (199 U/L), alanine transaminase (273 U/L), and total bilirubin (12.6 mg/dL). Dapsone was held due to suspicion for DILI. A liver biopsy was performed and disclosed non-necrotizing hepatic granulomas. After infectious and autoimmune causes were excluded, dapsone was determined to be the cause of her hepatic granulomas. Her bilirubin and liver enzymes steadily normalized over the next 4 weeks following discontinuation of dapsone. Conclusion Thus, dapsone-related liver injury may present following a steroid taper if dapsone and steroids had been initially started together. Hepatic granulomas, though rare, can be seen when dapsone causes DILI.
氨苯砜可引起药物性肝损伤(DILI),但很少引起肝肉芽肿的形成。我们描述了一位黄疸患者,他在肝活检中表现出肉芽肿,对氨苯砜的反应。她的症状只有在类固醇(也用于治疗坏疽性脓皮病)逐渐减少后才明显。本例患者为67岁女性,因黄疸1天住院。7周前,她开始同时使用氨苯砜和强的松治疗坏疽性脓皮病。在出现症状前4天停用类固醇。她的实验室新发现碱性磷酸酶(756 U/L)、天冬氨酸转氨酶(199 U/L)、丙氨酸转氨酶(273 U/L)和总胆红素(12.6 mg/dL)升高。Dapsone因涉嫌DILI而被拘留。肝活检显示非坏死性肝肉芽肿。在排除感染和自身免疫性原因后,确定氨苯砜是她肝肉芽肿的原因。她的胆红素和肝酶在停药后的4周内稳定恢复正常。因此,如果最初同时使用氨苯砜和类固醇,那么在类固醇逐渐减少后可能出现氨苯砜相关的肝损伤。肝肉芽肿,虽然罕见,可以看到当氨苯砜引起DILI。
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引用次数: 0
Gastric Glomus Tumors: The Roles of Endoscopic Ultrasound and Shared Decision-Making 胃粘膜瘤:内窥镜超声和共同决策的作用
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-08 DOI: 10.1159/000534643
Alexander Malik, M. Yousaf, Sami Samiullah, V. Tahan
Abstract Gastric glomus tumors (GGTs) are mesenchymal neoplasms with indolent behavior that originate from the subepithelial layers of the stomach and represent up to 1% of all gastric tumors. GGT is detected incidentally during esophagogastroduodenoscopy (EGD) in a proportion of patients. Endoscopic ultrasound (EUS) evaluation of GGT is essential to establish the diagnosis and to differentiate it from gastrointestinal stromal tumors or gastric neuroendocrine tumors. An 80-year-old man who presented for abdominal discomfort was incidentally found to have a gastric antral nodule on EGD. Endoscopic biopsy demonstrated moderately erythematous gastric antral mucosa and a 1.5 cm subepithelial lesion along the greater curvature. An EUS revealed a subepithelial 1.6 cm × 1.3 cm isoechoic, homogenous lesion with small calcifications. Immunohistochemical staining of the fine needle biopsy specimen of the nodule was positive for neoplastic cells, smooth muscle actin, vimentin, patchy muscle-specific actin, and synaptophysin. There were no atypical cytologic features. These findings were consistent with GGT. The patient was not deemed to be a candidate for surgical resection due to advanced age and resolution of his symptoms. A shared decision was made to pursue regular surveillance. EUS is essential for evaluation of GGT. Currently, there are no guideline recommendations for surveillance of GGT detected on routine EGD in asymptomatic individuals. A definitive surgical treatment with partial gastrectomy was favored in previously published literature. For asymptomatic patients with GGT or those with resolution of symptoms, careful surveillance with serial abdominal imaging and EUS may be a reasonable option, especially in older patients with poor surgical candidacy.
胃球囊瘤(GGTs)是一种起源于胃上皮下的间充质肿瘤,具有惰性行为,占所有胃肿瘤的1%。部分患者在食管胃十二指肠镜检查(EGD)中偶然发现GGT。内镜下超声(EUS)评估GGT是建立诊断和鉴别胃肠道间质瘤或胃神经内分泌肿瘤的必要条件。一个80岁的男人谁提出腹部不适,偶然发现有胃窦结节的EGD。内镜活检显示胃窦黏膜中度红斑和沿大弯曲1.5厘米的上皮下病变。EUS示上皮下1.6 cm × 1.3 cm等回声均匀病灶伴小钙化。结节细针活检标本免疫组化染色肿瘤细胞、平滑肌肌动蛋白、波形蛋白、斑片状肌特异性肌动蛋白、突触素阳性。没有不典型的细胞学特征。这些发现与GGT一致。由于高龄和症状消退,该患者不适合手术切除。双方共同决定进行定期监测。EUS是评估GGT的必要手段。目前,对无症状个体在常规EGD中检测到的GGT进行监测尚无指南建议。在先前发表的文献中,明确的手术治疗是部分胃切除术。对于无症状的GGT患者或症状缓解的患者,通过连续腹部成像和EUS进行仔细监测可能是一个合理的选择,特别是对于不适合手术的老年患者。
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引用次数: 0
Accessory Right Hepatic Artery Pseudoaneurysm Resulting in Biliary Obstruction. 右肝副动脉假性动脉瘤导致胆道阻塞。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-11-28 eCollection Date: 2023-01-01 DOI: 10.1159/000535039
Colin William Primrose, Nikolas Arestis

Introduction: Visceral pseudoaneurysms are prone to rupture and can cause mass effect on surrounding structures, with extrinsic compression on the biliary tree being a rare but challenging complication.

Case presentation: We report a case of a 48-year-old man with a history of alcohol excess who presented acutely unwell with jaundice. Imaging revealed a pseudoaneurysm of the accessory right hepatic artery extending into an adjacent pancreatic pseudocyst, leading to common bile duct compression. Successful management included pseudoaneurysm exclusion with a stent graft and concurrent alleviation of the biliary obstruction.

Conclusion: Managing pancreatic pseudocysts with biliary compression becomes complicated when an accompanying pseudoaneurysm is present, elevating the associated risk. In this case, stent graft exclusion of the pseudoaneurysm was the chosen approach to preserve arterial flow with potential for long-term patency. Delayed pseudoaneurysm diagnosis underscores the importance of comprehensive assessment in complex presentations, such as jaundiced alcoholic patients, where the possibility of pancreatitis episodes necessitates evaluation of the visceral vasculature for pseudoaneurysms.

内脏假性动脉瘤容易破裂,并对周围结构造成肿块效应,对胆道树的外源性压迫是一种罕见但具有挑战性的并发症。病例介绍:我们报告一例48岁的男性酒精过量的历史谁提出急性不适与黄疸。影像学显示右肝副动脉假性动脉瘤延伸至邻近胰腺假性囊肿,导致胆总管受压。成功的治疗包括假性动脉瘤排除支架移植和同时缓解胆道梗阻。结论:胰腺假性囊肿合并胆道压迫的治疗在伴有假性动脉瘤时变得复杂,增加了相关风险。在这种情况下,支架移植排除假性动脉瘤是选择的方法,以保持动脉流动的潜力,长期通畅。假性动脉瘤的延迟诊断强调了对复杂症状进行综合评估的重要性,如黄疸性酒精患者,其中胰腺炎发作的可能性需要对假性动脉瘤的内脏血管系统进行评估。
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引用次数: 0
Endoscopic Treatment of Colo-Colonic Intussusception in a Patient with Peutz-Jeghers Syndrome. Peutz-Jeghers综合征患者结肠-结肠肠套叠的内镜治疗。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-11-17 eCollection Date: 2023-01-01 DOI: 10.1159/000534201
Takeshi Fujima, Daisuke Saito, Hidenori Shibuta, Ryota Ogihara, Hiromu Morikubo, Ryo Ozaki, Sotaro Tokunaga, Shintaro Minowa, Tatsuya Mitsui, Miki Miura, Mari Hayashida, Yoshiko Watanabe, Jun Miyoshi, Minoru Matsuura, Junji Shibahara, Etsuji Ukiyama, Tadakazu Hisamatsu

A 19-year-old man with a history of Peutz-Jeghers syndrome (PJS) and two previous partial small bowel resections because of intussusception presented with lower abdominal pain. Computed tomography (CT) showed concentric multilayer and cord-like structures in the transverse colon. Colo-colonic intussusception was suspected and he was hospitalized. After two therapeutic enemas were unsuccessful, a colonoscopy was performed. The intussusception was reduced and a 40-mm transverse colon polyp with a thick stalk was resected. After the procedure, his abdominal pain was relieved and he was discharged on the sixth hospital day. This case and several previous reports suggest that PJS polyps with tumor diameter exceeding 30 mm and location in the transverse or sigmoid colon can cause intussusception. Endoscopic treatment should be considered for these lesions.

一名19岁男性,有Peutz-Jeghers综合征(PJS)病史,既往因肠套叠进行过两次部分小肠切除术,表现为下腹部疼痛。计算机断层扫描显示横结肠呈同心多层及索状结构。怀疑为结肠-结肠肠套叠,住院治疗。在两次治疗灌肠失败后,进行结肠镜检查。肠套叠缩小,切除40毫米厚的横结肠息肉。手术后,他的腹痛减轻,并于第六天出院。本病例和先前的几篇报道表明,肿瘤直径超过30mm且位于横结肠或乙状结肠的PJS息肉可引起肠套叠。对于这些病变应考虑内镜治疗。
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引用次数: 0
Large Cell Neuroendocrine Carcinoma of the Gallbladder: Where Survival Is a Rare Entity - Case Report and Review of the Literature. 胆囊癌的大细胞神经内分泌:生存是一个罕见的实体-病例报告和文献复习。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-11-16 eCollection Date: 2023-01-01 DOI: 10.1159/000534520
Samyak Dhruv, Kuldeepsinh P Atodaria, Indraneil Mukherjee, Anil Kankaria, Umed K Shah

Introduction: Carcinoma of the gallbladder is extremely rare, papillary adenocarcinoma comprises 90% of these cases. Although neuroendocrine neoplasms (NENs) comprise 0.5% of the cases of gallbladder cancer, the incidence is rising. NEN is classified into a well-differentiated neuroendocrine tumor and poorly differentiated neuroendocrine cancer (NEC). Histologically, NEC is small-cell or large-cell carcinoma. We present the extremely rare case, 15th in the literature to be precise, of large cell neuroendocrine carcinoma of the gallbladder.

Case presentation: A 72-year-old male presented to the emergency department with constipation and right upper quadrant pain for 3 months. Computed tomography scan of the abdomen demonstrated an ill-defined 7.2 × 4.9 cm hypodense lesion in the gallbladder fossa with extension into the liver. Histopathological and immunohistochemical analysis of the biopsy specimen confirmed the diagnosis of large cell neuroendocrine carcinoma of the gallbladder. He was started on palliative chemotherapy.

Conclusion: The plethora of tumors present in the gallbladder necessitates a search for risk factors for gallbladder neoplasia, and underscores the need to more carefully examine the nature of "asymptomatic gallstones." Further studies may reveal subclasses of cholelithiasis, gallbladder morphology, or imaging to define which patients should be followed more carefully, and may clarify additional risk factors for cancer of the gallbladder.

胆囊癌极为罕见,乳头状腺癌占90%。虽然神经内分泌肿瘤(NENs)占胆囊癌病例的0.5%,但发病率正在上升。NEN分为高分化神经内分泌肿瘤和低分化神经内分泌癌(NEC)。组织学上,NEC为小细胞癌或大细胞癌。我们报告一个极为罕见的病例,准确地说是文献中第15例,胆囊大细胞神经内分泌癌。病例介绍:一名72岁男性,因便秘和右上腹疼痛3个月就诊于急诊科。腹部计算机断层扫描显示胆囊窝有一个7.2 × 4.9 cm的低密度病灶,界限不清,并延伸至肝脏。活检标本的组织病理学和免疫组织化学分析证实了胆囊大细胞神经内分泌癌的诊断。他开始接受姑息性化疗。结论:胆囊中存在过多的肿瘤,需要寻找胆囊瘤变的危险因素,并强调需要更仔细地检查“无症状胆结石”的性质。进一步的研究可能会揭示胆石症的亚类、胆囊形态或影像学,以确定哪些患者应该更仔细地随访,并可能阐明胆囊癌的其他危险因素。
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引用次数: 0
A Case of Gastric Perforation Caused by Excessive Insufflation during Upper Gastrointestinal Endoscopy: Nonoperative Management. 上消化道内窥镜检查时过度充气致胃穿孔1例:非手术治疗。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-11-15 eCollection Date: 2023-01-01 DOI: 10.1159/000534866
Youn Su Park

Introduction: Upper gastrointestinal endoscopy is used to diagnose and treat upper gastrointestinal diseases, but it can also cause complications, including perforation. Perforation is a serious complication, so it is important to be aware of the risk factors in advance and to take precautions to prevent it.

Case presentation: We report a case of gastric perforation caused by excessive insufflation during upper gastrointestinal endoscopy in a 64-year-old man with a history of multiple active gastric ulcers. During the endoscopy, the patient did not cooperate and insufflation was performed for a prolonged period of time. This led to a mucosal laceration and a hole suspected to be a perforation on the lesser curvature of the gastric body. The patient was treated nonsurgically with fasting, intravenous fluids, antibiotics, intravenous proton pump inhibitors, and blood transfusions. No leakage was observed on the follow-up computed tomography scan, and the perforation site was completely healed 2 months later.

Conclusion: In this case, the patient was successfully treated with conservative therapy alone. The treatment of gastric perforation caused by endoscopy has shifted toward conservative therapy in recent years.

上消化道内窥镜检查用于诊断和治疗上消化道疾病,但也会引起并发症,包括穿孔。穿孔是一种严重的并发症,因此提前了解危险因素并采取预防措施是很重要的。病例介绍:我们报告了一个64岁的男性,有多发性活动性胃溃疡病史,在上消化道内镜检查时过度充气导致胃穿孔的病例。在内镜检查期间,患者不配合,进行了长时间的充气。这导致粘膜撕裂和一个洞怀疑是胃体小弯曲穿孔。患者接受非手术治疗,包括禁食、静脉输液、抗生素、静脉注射质子泵抑制剂和输血。随访计算机断层扫描未见渗漏,2个月后穿孔部位完全愈合。结论:本例患者采用单纯保守治疗,治疗成功。近年来,内镜引起的胃穿孔的治疗逐渐转向保守治疗。
{"title":"A Case of Gastric Perforation Caused by Excessive Insufflation during Upper Gastrointestinal Endoscopy: Nonoperative Management.","authors":"Youn Su Park","doi":"10.1159/000534866","DOIUrl":"10.1159/000534866","url":null,"abstract":"<p><strong>Introduction: </strong>Upper gastrointestinal endoscopy is used to diagnose and treat upper gastrointestinal diseases, but it can also cause complications, including perforation. Perforation is a serious complication, so it is important to be aware of the risk factors in advance and to take precautions to prevent it.</p><p><strong>Case presentation: </strong>We report a case of gastric perforation caused by excessive insufflation during upper gastrointestinal endoscopy in a 64-year-old man with a history of multiple active gastric ulcers. During the endoscopy, the patient did not cooperate and insufflation was performed for a prolonged period of time. This led to a mucosal laceration and a hole suspected to be a perforation on the lesser curvature of the gastric body. The patient was treated nonsurgically with fasting, intravenous fluids, antibiotics, intravenous proton pump inhibitors, and blood transfusions. No leakage was observed on the follow-up computed tomography scan, and the perforation site was completely healed 2 months later.</p><p><strong>Conclusion: </strong>In this case, the patient was successfully treated with conservative therapy alone. The treatment of gastric perforation caused by endoscopy has shifted toward conservative therapy in recent years.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"17 1","pages":"327-332"},"PeriodicalIF":0.6,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10651181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Successful Endoscopic Removal of Anisakis Larva that Deeply Invaded the Gastric Mucosa Using Jumbo Forceps. 大钳内镜下成功切除深侵胃粘膜的Anisakis Larva。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-11-08 eCollection Date: 2023-01-01 DOI: 10.1159/000533808
Toshio Arai, Takehito Kunogi, Takahiro Kinebuchi, Yasuhiro Nakano, Koji Nishikawa, Hiromu Sugiyama

Anisakiasis is a parasitic disease caused by the ingestion of raw or uncooked seafood infected with third-stage larvae of anisakid nematodes. Generally, the larvae parasites live at the surface of the mucosa, but in this case, the larva deeply invaded its head into the gastric mucosa and was not removable with conventional biopsy forceps. In our case, we demonstrated the usefulness of jumbo forceps to remove the Anisakis larva in such a situation.

Anisakidisis是一种由摄入生的或未煮熟的海鲜引起的寄生虫病,感染了anisakid线虫的第三阶段幼虫。通常,幼虫寄生在粘膜表面,但在这种情况下,幼虫的头部深深侵入胃粘膜,无法用传统的活检钳取出。在我们的案例中,我们证明了大型钳子在这种情况下去除Anisakis幼虫的有用性。
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引用次数: 0
Secondary Colo-Colic Intussusception Caused by Giant Polyp of Sigmoid Colon in a 5-Year-Old Girl. 一名5岁女孩乙状结肠巨大息肉引起的继发性结肠肠套叠。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-11-08 eCollection Date: 2023-01-01 DOI: 10.1159/000528436
Tan Haizhi, Xiao Xiaobing, Deng Jianrong

Intussusception is common in infants and young children. The most common type is small intestinal intussusception or ileo-colic intussusception. Colonic intussusception is rare. Intestinal polyps, especially large polyps or multiple polyps, can cause intussusception. Here, we report a rare case of colo-colic intussusception caused by a giant juvenile polyp of sigmoid colon, and the patient achieved good clinical effect through polypectomy under colonoscopy. So, when children have colonic intussusception, the possibility of colonic polyps should be considered.

肠套叠常见于婴幼儿。最常见的类型是小肠肠套叠或回结肠肠套叠。结肠肠套叠是罕见的。肠息肉,尤其是大息肉或多发性息肉,可引起肠套叠。在这里,我们报告了一例罕见的由乙状结肠巨大的幼年息肉引起的结肠-结肠肠套叠,该患者在结肠镜下通过息肉切除术取得了良好的临床效果。因此,当儿童出现结肠肠套叠时,应考虑结肠息肉的可能性。
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引用次数: 0
An Autopsy Case of Ruptured Hepatic Angiosarcoma Treated by Transcatheter Arterial Embolization. 经导管动脉栓塞治疗破裂肝血管肉瘤一例尸检报告。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1159/000533552
Toshiki Entani, Kazuto Tajiri, Akira Noguchi, Aiko Murayama, Nozomu Muraishi, Yuka Hayashi, Ichiro Yasuda

An 80-year-old Japanese man presented to our hospital with intra-abdominal hemorrhage due to a ruptured liver tumor. Transcatheter arterial embolization (TAE) temporarily achieved hemostasis, but he died following re-rupture 4 days later. Based on autopsy findings, the liver tumor was diagnosed as hepatic angiosarcoma. Embolic agents used during embolization were identified within the hepatic small interlobular arteries. However, there were no findings of tumor cell necrosis or ischemic change in the angiosarcoma. In the present case, TAE alone did not induce ischemia-induced tumor necrosis, suggesting that TAE might be unsuitable to treat hepatic angiosarcoma. Treatment optimization for ruptured hepatic angiosarcoma is desired.

一位80岁的日本男性因肝肿瘤破裂而出现腹腔内出血。经导管动脉栓塞(TAE)暂时止血,但4天后再次破裂后死亡。根据尸检结果,肝脏肿瘤被诊断为肝脏血管肉瘤。在肝小叶间小动脉内发现栓塞期间使用的栓塞剂。然而,在血管肉瘤中没有发现肿瘤细胞坏死或缺血性改变。在目前的情况下,单独的TAE不能诱导缺血诱导的肿瘤坏死,这表明TAE可能不适合治疗肝脏血管肉瘤。肝血管肉瘤破裂的最佳治疗是需要的。
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引用次数: 0
An Unusual Complication of Self-Expandable Metal Stent Placement in Malignant Sigmoid Obstruction. 恶性乙状结肠梗阻自膨胀金属支架置入术的异常并发症。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1159/000533615
Qingjie Kang, Denghua Hu, Guangxu Wen, Zhengqiang Wei

Self-expandable metal stent (SEMS) for malignant colorectal obstruction is widely used as a bridge to elective surgery or palliative treatment. However, with the increasing use of SEMS for treatment, complication rates associated with stents have been raised as a concern. We experienced a rare migration-related complication that a stent partially migrated out of the anus with an incarceration. A 62-year-old man was admitted with sigmoid malignant obstruction. Due to multiple metastases, he refused to undergo colostomy, and an uncovered SEMS was placed. Subsequently, he started chemotherapy. Seven months after placement, the stent migrated into the rectum. After unsuccessful attempts to extract the stent, he sought our assistance. We observed that half of the stent was outside the anus, and a 15 mm lump of mucosa was embedded in the proximal end of the stent. After several attempts, we successfully removed the SEMS. Stent incarceration following migration is not a common occurrence, but it serves as a reminder that clinicians need to be more vigilant about complications that may arise after stent implantation. We describe this unusual complication and share our experience about the removal of the stent.

自膨胀金属支架(SEMS)治疗恶性结直肠梗阻被广泛用作选择性手术或姑息治疗的桥梁。然而,随着SEMS治疗的使用越来越多,与支架相关的并发症发生率也越来越令人担忧。我们经历了一种罕见的移行相关并发症,支架部分移出肛门并伴有嵌顿。一名62岁男子因乙状结肠恶性梗阻入院。由于多处转移,他拒绝接受结肠造口术,并放置了未覆盖的SEMS。随后,他开始化疗。放置后7个月,支架移入直肠。在尝试取出支架失败后,他寻求我们的帮助。我们观察到支架的一半在肛门外,支架的近端嵌入了一块15毫米的粘膜。经过多次尝试,我们成功地删除了SEMS。迁移后支架嵌顿并不常见,但它提醒临床医生需要对支架植入后可能出现的并发症更加警惕。我们描述了这种不寻常的并发症,并分享了我们移除支架的经验。
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引用次数: 0
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Case Reports in Gastroenterology
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