病例报告:未报告的莱姆梅尔综合征病例,凸显十二指肠肿块的诊断难题。

IF 0.8 Q4 SURGERY
Océane Wautelet, Nicolas Tinton, Emanuel Cambier, Francisco da Rocha
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引用次数: 0

摘要

我们介绍了一个病例,患者 67 岁,有胃旁路手术病史,最近被诊断出患有一个 6 厘米的十二指肠肿块,导致胆管狭窄。尽管我们尽了最大努力,但仍无法在内镜下探查到该肿瘤,因此必须进行手术治疗。在手术探查过程中,我们发现十二指肠憩室内充满结石,导致胆管阻塞,这是莱姆尔综合征的一种表现。这种罕见病症的特点是在没有胆总管结石或肿瘤的情况下出现梗阻性黄疸,继发于胰腺周围憩室的扩张。虽然这种疾病通常通过内镜检查进行治疗,但由于患者曾接受过减肥手术(胃旁路手术),尽管我们多次尝试,但内镜检查仍无法进入,这使得我们的诊断和治疗方法变得更加复杂。本病例报告揭示了罕见病理和手术改变解剖结构同时存在所带来的挑战,这种情况在日常手术实践中越来越多地遇到。在这种情况下,探查手术将继续发挥重要作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Case Report: An Unreported Presentation of Lemmel Syndrome Highlighting Diagnostic Challenges of Duodenal Masses.

We present a case involving a 67-year-old patient with a medical history of gastric bypass who was recently diagnosed with a 6-centimeter duodenal mass causing biliary duct stenosis. Despite our best efforts, we were unable to access this tumor endoscopically, necessitating surgical intervention. During the surgical exploration, we discovered a duodenal diverticulum filled with stones, leading to the obstruction of the biliary ductâ?"a manifestation of Lemmel syndrome. This rare condition is characterized by obstructive jaundice in the absence of choledocholithiasis or tumors and is secondary to dilatation of peri-ampullary diverticula. While it is typically managed through endoscopy, our diagnostic and therapeutic approach was complicated by the patient's history of bariatric surgery (gastric bypass), making endoscopic access impossible despite our multiple attempts. This case report sheds light on the challenges posed by the concurrence of a rare pathology and surgically modified anatomy, which is increasingly encountered in daily surgical practice. In such situations, exploratory surgery continues to play a significant role.

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来源期刊
Chirurgia
Chirurgia Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
75
审稿时长
4-8 weeks
期刊介绍: Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither appeared, nor were sent for publication in other periodicals, can be published. You can send original articles, new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and, depending on publication space, - reviews of some articles of general interest to surgeons from other publications. Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and participation notes in other scientific meetings. Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please submit these letters to the editor through our online system.
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