胃重复表现为腹膜后囊性病变1例

doi:10.19723/j.issn.1671-167X.2019.04.030

摘要/Abstract

摘要：

胃重复是一种罕见的先天性异常疾病,约占重复消化道畸形的4%,通常于出生前或婴儿时诊断。成人腹膜后胃重复病例文献报道极为罕见,多无症状或症状无特异性,影像学检查特异性差,易误诊为其他腹膜后囊性病变。腹膜后胃重复可通过腹部增强CT、胃内超声及超声引导细针活检等检查的典型表现明确诊断。北京大学人民医院于2019年3月收治1例外院CT提示腹膜后囊性病变的成年女性患者,术前北京大学人民医院腹部增强CT提示左肾上方囊性灶,最大截面9.0 cm×5.2 cm,需要鉴别淋巴囊肿及其他,病灶考虑来源胃可能大。术前未明确腹膜后胃重复诊断,用腹腔镜经腹腔探查见囊性病变位于腹膜后,胰腺、左侧肾及肾上腺受压可完全分离,囊性病变顶部与胃小弯相连但与胃腔内不通,成功完整切除腹膜后囊性病变,周围脏器无损伤,经术后病理结合术中所见明确诊断腹膜后胃重复。患者术后1周出院,无胃肠道损伤,饮食排便正常,因此腹膜后囊性病变鉴别诊断应考虑到腹膜后胃重复可能,当CT可见典型表现或肿物与胃壁分界不清时,可进一步行胃内超声及超声引导下细针活检明确诊断。明确诊断或怀疑腹膜后胃重复的患者,可行腹腔镜经腹腔途径完整切除腹膜后胃重复囊肿,并彻底修复胃壁。

关键词: 胃重复, 腹膜后囊性病变, 诊断, 治疗

Abstract:

Gastric duplication is a rare congenital anomaly accounting to 4% of all gastrointestinal tract duplications. It is usually diagnosed pre-natally or during infancy. Retroperitoneal gastric duplication is very rare in adult patients. It is generally asymptomatic or presents with non-specific symptoms. The sensitivity of classical imaging modalities for retroperitoneal gastric duplication is weak. Retroperitoneal gastric duplication could be misdiagnosed as other retroperitoneal cystic lesions and it could be definitely diagnosed by typical findings of abdominal enhanced computed tomography (CT) and endoscopic ultrasonography (EUS) plus EUS:guided fine needle aspiration biopsy in gastric duplicated cyst. A female adult patient was diagnosed by an exceptional hospital CT as retroperitoneal cystic lesion and was admitted in our hospital in March 2019. The abdominal enhanced CT in our hospital preoperatively indicated a cystic lesion above the left kidney and the maximum cross section was 9.0 cm ×5.2 cm. Lymphocysts and others should be identified and the lesion might be from the stomach. The retroperitoneal gastric duplication was not diagnosed before operation. In the operation laparoscopy revealed the cystic lesion in the retroperitoneum. The pancreas, left adrenal gland, and left kidney were compressed by the cystic lesion. The top of the lesion was connected with the small curvature of the stomach, but it was not communicated with the stomach. The retroperitoneal cystic lesion was completely excised and the surrounding organs were not damaged. The retroperitoneal gastric duplication was clearly diagnosed by the findings in the operation and the pathology of the lesion. The patient was discharged a week after surgery without gastrointestinal and pancreatic injuries. Therefore, the differential diagnosis of retroperitoneal cysts should consider the possibility of retroperitoneal gastric duplication. For patients with typical CT findings or unclear boundaries between the tumor and the stomach wall, gastric duplication could be diagnosed by EUS plus EUS:guided fine needle aspiration biopsy in the cyst. Retroperitoneal gastric duplication cyst could be completely excised by laparoscopy through abdominal cavity and the stomach wall could be completely repaired.

Key words: Gastric duplication, Retroperitoneal cystic lesion, Diagnosis, Treatment

中图分类号:

R691.1

于路平,李清,刘士军,王焕瑞,徐涛. 胃重复表现为腹膜后囊性病变1例[J]. 北京大学学报（医学版）, 2019, 51(4): 764-768.

Lu-ping YU,Qing LI,Shi-jun LIU,Huan-rui WANG,Tao XU. A case of gastric duplication presenting as a retroperitoneal cystic lesion[J]. Journal of Peking University(Health Sciences), 2019, 51(4): 764-768.

图/表 8

图1

图2

图3

图4

图5

图6

图7

图8

参考文献 20

[1]	Ford WD, Guenlfand M, Lopez PJ , et al. Laparoscopic excision of a gastric duplication cyst detected on antenatal ultrasound scan[J]. J Pediatr Surg, 2004,39(10):8-10.
[2]	Bal HS, Kisku S, Sen S , et al. A retroperitoneal enteric duplication cyst communicating with the right upper ureter in an infant[J/OL]. BMJ Case Rep, 2014( 2014-05-09)[2019-03-01]. .
[3]	Geng YH, Wang CX, Li JT , et al. Gastric foregut cystic developmental malformation: case series and literature review[J]. World J Gastroenterol, 2015,21(2):432-438.
[4]	Murakami S, Isozaki H, Shou T , et al. Foregut duplication cyst of the stomach with pseudostratified columnar ciliated epithelium[J]. Pathol Int, 2008,58(3):187-190.
[5]	Sinha A, Saluja SS, Gamanagatti S . Gastric duplication cyst with macroscopic serosal heterotopic pancreas[J]. JOP, 2010,11(5):470-473.
[6]	Rowling JT . Some observations on gastric cysts[J]. Br J Surg, 1959,46(199):441-445.
[7]	Blais C, Masse S . Preoperative ultrasound diagnosis of a gastric duplication cyst with ectopic pancreas in a child[J]. J Pediatr Surg, 1995,30(9):1384-1386.
[8]	Thomopoulos T, Farin C, Navez B . Total laparoscopic treatment of an adult gastric duplication cyst with intrapancreatic extension[J]. Am J Case Rep, 2016,17:352-356.
[9]	Upadhyay N, Gomez D, Button MF , et al. Retroperitoneal enteric duplication cyst presenting as a pancreatic cystic lesion: a case report[J]. JOP, 2006,7(5):492-495.
[10]	Terry NE, Senkowski CK, Check W , et al. Retroperitoneal foregut duplication cyst presenting as an adrenal mass[J]. Am Surg, 2007,73(1):89-92.
[11]	Kuraoka K, Nakayama H, Kagawa T , et al. Adenocarcinoma arising from a gastric duplication cyst with invasion to the stomach:a case report with literature review[J]. J Clin Pathol, 2004,57(4):428-431.
[12]	Eloubeidi MA, Cohn M, Cerfolio RJ , et al. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of foregut duplication cysts: the value of demonstrating detached ciliary tufts in cyst fluid[J]. Cancer, 2004,102(4):253-258.
[13]	Ponder TB, Collins BT . Fine needle aspiration biopsy of gastric duplication cysts with endoscopic ultrasound guidance[J]. Acta Cytol, 2003,47(4):571-574.
[14]	Castillo-Fernandez AL, Vazquez-Rueda F, Canete MD , et al. Retroperitoneal gastric duplication mimicking a prenatal adrenal cyst[J]. Congenit Anom(Kyoto), 2018,58(4):141-142.
[15]	Chen PH, Lee JY, Yang SF , et al. A retroperitoneal gastric duplication cyst mimicking a simple exophytic renal cyst in an adolescent[J]. J Pediatr Srug, 2010,45(10):5-8.
[16]	Bailey CE, Fritz MB, Webb L , et al. Gastric duplication cyst masquerading as a mucinous pancreatic cyst:case report and literature review[J]. Ann R Coll Surg Engl, 2014,96(1):88-90.
[17]	Malgras B, Souraud JB, Chapuis O . Retroperitoneal gastric duplication cyst[J]. J Visc Surg, 2014,151(6):479-480.
[18]	Ren HX, Duan LQ, Wu XX , et al. Laparoscopic resection of gastric duplication cysts in newborns: a report of five cases[J]. BMC Srug, 2017,17(1):37.
[19]	Rizzo R, Lisi G, Marino N , et al. Robot-assisted resection of gastric duplication cysts in a child: a detailed case report[J]. Pediatr Med Chir, 2018,40(2):52-55.
[20]	王海涛, 张继伟, 阎乙夫 , 等. 左肾上腺区特殊囊性占位病变的诊治附胃重复囊肿二例报告[J]. 中华泌尿外科杂志, 2012,33(12):906-910.

相关文章 15

[1]	陈心心, 唐哲, 乔艳春, 荣文笙. 北京市密云区4岁儿童患龋状况及其与龋活跃性检测的相关性[J]. 北京大学学报（医学版）, 2024, 56(5): 833-838.
[2]	钟华, 李原, 徐丽玲, 白明欣, 苏茵. ¹⁸F-FDG PET/CT在风湿免疫病中的应用[J]. 北京大学学报（医学版）, 2024, 56(5): 853-859.
[3]	刘家骏, 刘国康, 朱玉虎. 免疫相关性重症肺炎1例[J]. 北京大学学报（医学版）, 2024, 56(5): 932-937.
[4]	黄教悌,胡菁,韩博. 治疗相关神经内分泌前列腺癌机制研究与靶向治疗新进展[J]. 北京大学学报（医学版）, 2024, 56(4): 557-561.
[5]	李正芳,罗采南,武丽君,吴雪,孟新艳,陈晓梅,石亚妹,钟岩. 抗氨基甲酰化蛋白抗体在诊断类风湿关节炎中的应用价值[J]. 北京大学学报（医学版）, 2024, 56(4): 729-734.
[6]	侯婉音,董捷. 腹膜透析患者获得性肾囊肿出血3例[J]. 北京大学学报（医学版）, 2024, 56(3): 546-550.
[7]	李文菁,张保宙,李恒,赖良鹏,杜辉,孙宁,龚晓峰,李莹,王岩,武勇. 胫距跟融合治疗终末期踝和后足病变的中短期临床结果[J]. 北京大学学报（医学版）, 2024, 56(2): 299-306.
[8]	冯琦琛,盖铄,王昌明,李选. 经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中的应用[J]. 北京大学学报（医学版）, 2024, 56(2): 322-325.
[9]	彭圣嘉,祁雨,孙丽杰,李丹,王新宇,韩江莉,陈宝霞,张媛. 传入压力反射衰竭合并低钠血症1例[J]. 北京大学学报（医学版）, 2024, 56(2): 357-361.
[10]	陈晨,梁宇红. 复杂根管上颌磨牙的根管治疗3例[J]. 北京大学学报（医学版）, 2024, 56(1): 190-195.
[11]	任晓萌,李凯一,李春蕾. 基于转录组测序探索口腔扁平苔藓局部激素治疗敏感性相关分子特征[J]. 北京大学学报（医学版）, 2024, 56(1): 32-38.
[12]	张晗,秦亦瑄,韦帝远,韩劼. 牙周炎患者种植修复维护治疗依从性的影响因素[J]. 北京大学学报（医学版）, 2024, 56(1): 39-44.
[13]	周颖,赵宁,黄竑远,李庆祥,郭传瑸,郭玉兴. 双层软组织缝合封闭技术在下颌骨中早期药物相关性颌骨骨坏死患者手术治疗中的应用[J]. 北京大学学报（医学版）, 2024, 56(1): 51-56.
[14]	邹雪,白小娟,张丽卿. 艾拉莫德联合托法替布治疗难治性中重度类风湿关节炎的疗效[J]. 北京大学学报（医学版）, 2023, 55(6): 1013-1021.
[15]	姚海红,杨帆,唐素玫,张霞,何菁,贾园. 系统性红斑狼疮及成人Still病合并巨噬细胞活化综合征的临床特点及诊断指标[J]. 北京大学学报（医学版）, 2023, 55(6): 966-974.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed