急性肠梗阻显示未确诊空肠结节病59岁女性。

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-04-16 eCollection Date: 2025-05-01 DOI:10.1097/MS9.0000000000003085
Yumna Njoum, Mohammed Hinnawi, Khaled Alshawwa, Hamza A Abdul-Hafez, Omar AbuZaydeh, Bashar Jaber
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引用次数: 0

摘要

背景:结节病是一种病因不明的肉芽肿性疾病,组织病理学上以非干酪化性肉芽肿为定义。虽然90%的病例累及肺和纵隔淋巴结,但临床可识别的胃肠道结节病仅发生在0.1-0.9%的患者中,小肠累及的病例仅占所有病例的0.03%,并且当它确实发生时,通常在多系统疾病患者的病程晚期。病例介绍:在此,我们报告一个59岁的病人,他表现为完全性空肠梗阻和胃肠道出血。影像显示空肠增厚及肠系膜淋巴结病变。后来,术中发现由空肠狭窄和肠系膜淋巴结肿大继发于未确诊的结节病引起。术后并发症包括肝血肿和胃肠道出血。经多学科治疗后病情稳定。1年随访显示纵隔淋巴结病变,未累及肺部。讨论:为了提供个性化的治疗护理和随访,胃肠道结节病是一种复杂的,可能致命的疾病,需要多学科的方法和早期临床怀疑。没有事先诊断,结节病必须考虑到急性肠阻塞的可能原因。结论:本病例空肠结节病的独特之处在于罕见的发病部位,缺乏预先诊断的结节病,坏死的空肠切除部分提示肠缺血。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute intestinal obstruction revealing an undiagnosed jejunal sarcoidosis in a 59-year-old female.

Background: Sarcoidosis is a granulomatous illness with no known cause, defined histopathologically by noncaseating granulomas. While 90% of cases involve the lungs and mediastinal lymph nodes, clinically recognizable gastrointestinal sarcoidosis occurs in only 0.1-0.9% of patients, with small bowel involvement occurring in as few as 0.03% of all cases, and when it does occur, it is usually late in the disease course in patients with multisystem disease.

Case presentation: Herein, we report a case of 59-year-old patient who presented with a picture of complete jejunal obstruction and gastrointestinal bleeding. Imaging revealed jejunal thickening and mesenteric lymphadenopathy. Later, intra-operatively, it be found caused by a jejunal stricture and enlarged mesenteric lymph nodes secondary to an undiagnosed sarcoidosis. Postoperative complications included hepatic hematoma and gastrointestinal bleeding. She stabilized after multidisciplinary management. A 1-year follow-up showed mediastinal lymphadenopathy without pulmonary involvement.

Discussion: To provide individualized therapeutic care and follow-up, gastrointestinal sarcoidosis is a complex, possibly lethal condition that requires a multidisciplinary approach and early clinical suspicion. Without a prior diagnosis, sarcoidosis must be taken into account as a possible cause of acute intestinal blockage.

Conclusion: Our case of jejunal sarcoidosis is unique for the rarity of disease location, the lack of pre-existing diagnosed sarcoidosis, and the necrotized jejunal resected segment indicating bowel ischemia.

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来源期刊
Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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5.90%
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