一例青少年患者肠套叠的意外病因。

Yasir Alshareefy, Ali Alshareefy
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摘要

肠套叠是儿童、青年和老年患者急性和亚急性小肠梗阻的常见原因;然而,尽管人们对这种疾病的认识不断提高,各年龄段被诊断出患有这种疾病的患者数量也在增加,但其临床和诊断方法仍然具有挑战性。一名17岁的女孩到我们的消化科门诊就诊,主诉6个月的复发性右髂窝疼痛,伴有恶心和呕吐,有时没有病史。最初的血液检查显示CRP轻微升高(9.1 mg/L),粪便钙保护蛋白显著升高(>1000µg/g)。腹部和骨盆的计算机轴位断层扫描显示回盲肠套叠,没有小肠梗阻或大肠梗阻的证据。在随后的结肠镜检查中,发现了一个5厘米的肿块突出穿过回盲瓣,并进行了多次活检进行组织学分析,证实了伯基特淋巴瘤的诊断。手术切除病变并讨论辅助化疗计划。从本病例中吸取的教训是扩大原因不明的复发性腹痛的鉴别诊断范围,包括肠套叠,并通过适当的诊断方法积极排除,解决其潜在的恶性病因,不分年龄。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Unexpected Etiology of Intussusception in an Adolescent Patient.

Intussusception is a common cause of acute and subacute small bowel obstruction in children, young, and older patients; however, despite increasing awareness of the condition and the number of patients diagnosed with it across all ages, its clinical and diagnostic approach remains challenging. A 17-year-old girl attended our gastroenterology outpatient department complaining of a 6-month history of recurrent right iliac fossa pain associated with nausea and vomiting at times with no past medical history of note. Initial blood tests revealed a slightly raised CRP (9.1 mg/L) and a significantly elevated fecal calprotectin (>1000 µg/g). Computed axial tomography scan of the abdomen and pelvis revealed ileocecal intussusception with no evidence of small or large bowel obstruction. On subsequent colonoscopy a 5-cm mass protruding through the ileocecal valve was identified and multiple biopsies were taken for histological analysis, which confirmed a diagnosis of Burkitt's lymphoma. The lesion was surgically resected and plans for adjuvant chemotherapy were discussed. The learning lessons to take from this case are to widen the list of differential diagnoses of unexplained recurrent abdominal pain to include intussusception and to actively rule it out with an appropriate diagnostic approach that addresses its potential malignant etiology across all ages.

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