A jejunal adenoma with high-grade dysplasia in the excluded limb 25 years after biliopancreatic diversion: A case report

IF 2.4 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Obesity research & clinical practice Pub Date : 2026-09-01 Epub Date: 2026-09-28 DOI:10.1016/j.orcp.2026.09.007

Francesco Saverio Papadia, Federica Grillo, Luca Mastracci, Franco De Cian

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引用次数: 0

Abstract

Biliopancreatic diversion (BPD) creates a biliopancreatic limb that is inaccessible to conventional endoscopic surveillance, and its long-term neoplastic risk is unknown. A woman in her late 40 s presented 25 years after BPD with recurrent protein malnutrition and subocclusive symptoms. Computed tomography showed jejunal intussusception. At surgery, the intussusception was localized to the proximal biliopancreatic limb, 10–20 cm from the ligament of Treitz and remote from the entero-enterostomy. A 2.6-cm tubulovillous adenoma with focal high-grade dysplasia was found at the corresponding site and was completely excised. This appears to be the first reported high-grade dysplastic adenoma in an excluded biliopancreatic limb after BPD. The finding shows that a conventional dysplastic adenoma can arise in this compartment and makes an adenoma-carcinoma pathway biologically plausible, but a single case cannot establish causality, incidence, or risk in other bariatric procedures. Routine imaging surveillance is not supported by current evidence. However, an intussusception remote from the entero-enterostomy, particularly when associated with recurrent obstructive symptoms, warrants evaluation for a structural lead point.

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胆胰转移术后25年的排除肢空肠腺瘤伴高度发育不良1例。

胆道胰腺转移术（BPD）产生了传统内镜监测无法达到的胆道胰腺肢体，其长期肿瘤风险尚不清楚。一位40多岁的女性 在BPD后25年出现复发性蛋白质营养不良和亚封闭症状。计算机断层扫描显示空肠肠套叠。手术时，肠套叠定位于胆胰近端，距离Treitz韧带10-20 cm，远离肠-肠造口。在相应部位发现2.6 cm管绒毛状腺瘤伴局灶性高级别发育不良，并完全切除。这似乎是BPD后在排除的胆胰肢体中首次报道的高级别发育不良腺瘤。这一发现表明，传统的发育不良腺瘤也可能发生在该间室，这使得腺瘤-癌途径在生物学上是合理的，但单个病例不能确定其他减肥手术的因果关系、发病率或风险。常规影像监测目前没有证据支持。然而，远离肠-肠造口的肠套叠，特别是当伴有复发性梗阻性症状时，需要对其结构导点进行评估。

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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来源期刊

Obesity research & clinical practice 医学-内分泌学与代谢

CiteScore

7.10

自引率

0.00%

发文量

审稿时长

49 days

期刊介绍： The aim of Obesity Research & Clinical Practice (ORCP) is to publish high quality clinical and basic research relating to the epidemiology, mechanism, complications and treatment of obesity and the complication of obesity. Studies relating to the Asia Oceania region are particularly welcome, given the increasing burden of obesity in Asia Pacific, compounded by specific regional population-based and genetic issues, and the devastating personal and economic consequences. The journal aims to expose health care practitioners, clinical researchers, basic scientists, epidemiologists, and public health officials in the region to all areas of obesity research and practice. In addition to original research the ORCP publishes reviews, patient reports, short communications, and letters to the editor (including comments on published papers). The proceedings and abstracts of the Annual Meeting of the Asia Oceania Association for the Study of Obesity is published as a supplement each year.