粘膜下脂肪瘤是结肠阻塞手术治疗的罕见病因:病例系列和文献综述

M. Khoury
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摘要

结肠粘膜下脂肪瘤最早由鲍尔(Bauer)于 1757 年描述,是一种脂肪瘤,大小很少超过 2 厘米,因此很少有症状。这些肿瘤绝大多数是在结肠镜检查、计算机断层扫描(CT)、手术或尸检时偶然发现的,最常见的位置是在升结肠靠近盲肠的位置。黏膜下结肠脂肪瘤是结肠中第二常见的良性肿瘤,由于其无症状或患者症状间歇性、非特异性,通常很难诊断。在这一领域,出现腹痛、出血、腹泻或便秘等症状最常见于大小超过 2 厘米的脂肪瘤。此外,继发于结肠腔内狭窄或肠套叠的梗阻多见于较大的脂肪瘤,最常见的是生长超过 4 厘米的脂肪瘤,因此需要进行手术或内镜切除。然而,由于结肠镜和 CT 的使用率提高,如今这类病变越来越多地被暴露出来,而且并发症也会随之出现,因此在预防并发症的道路上,有必要制定完善的指南,为这类息肉的管理提供建议。在这篇文章中,我们对结肠粘膜下脂肪瘤进行了文献综述,同时介绍了我们在阻塞性结肠脂肪瘤方面的经验,这是一个回顾性病例系列,由 4 名具有特征性和人口统计学特征的患者组成,同时介绍了他们因阻塞性症状入住我们的三级医疗中心后的治疗情况。
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Sub-Mucosal Lipoma a Rare Cause of Colonic Obstruction Managed Surgically: Case Series and Literature Review
Sub-mucosal lipomas of the colon, as first described by Bauer in 1757 are fatty tumors, rarely greater than 2 cm in size and hence rarely symptomatic. The vast majority of these tumors are subjected to be found incidentally during a colonoscopy, Computed Tomography (CT) scan, surgery, or autopsy and are most often located in the ascending colon near the cecum. Referred to second most common benign tumour of the colon, sub-mucosal colonic lipomas are often difficult to diagnose because of their asymptomatic nature or the intermittent, non-specific nature of patients’ symptoms. In this domain, development of symptoms manifesting as abdominal pain, hemorrhage, diarrhea, or constipation are most commonly encountered with lipomas of size greater than 2 cm. Furthermore, obstruction secondary to colonic intra-luminal narrowing or intussusception is mostly reserved for larger lipomas, most commonly those growing more than 4 cm in size and hence requiring surgical or endoscopic resection. However, as such lesions are more often being exposed nowadays owing to the enhanced utilization of colonoscopy and CT and the fact that complications can prevail, both rises the need of settling well established guidelines advising the management of such polyps, on the road of preventing consequent complications. In this article and in trial of us addressing this rare entity, shedding the light on its importance and further elaborating on its significant consideration in working up bowel obstructive pathologies, we present a literature review of colonic sub-mucosal lipomas, along with our experience in obstructive colonic lipomas, in a retrospective case series constituted of 4 characteristically and demographically studied patients, along with the management after being admitted to our tertiary care center for obstructive symptoms.
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