ABSTRACT
AIM: To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter. METHODS: Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound. RESULTS: All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported. CONCLUSION: EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.
Subject(s)
Carcinoid Tumor/surgery , Intestinal Mucosa/surgery , Intestinal Neoplasms/surgery , Proctoscopes , Proctoscopy/instrumentation , Rectal Neoplasms/surgery , Ultrasonography, Interventional/instrumentation , Adult , Aged , Aged, 80 and over , Biopsy , Carcinoid Tumor/diagnostic imaging , Carcinoid Tumor/pathology , Colonoscopy , Equipment Design , Female , Humans , Intestinal Mucosa/diagnostic imaging , Intestinal Mucosa/pathology , Intestinal Neoplasms/diagnostic imaging , Intestinal Neoplasms/pathology , Male , Middle Aged , Miniaturization , Proctoscopy/adverse effects , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/pathology , Time Factors , Treatment Outcome , Tumor Burden , Ultrasonography, Interventional/adverse effectsABSTRACT
Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postoperative pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.
Subject(s)
Gastrointestinal Hemorrhage/diagnosis , Magnetic Resonance Imaging , Meckel Diverticulum/diagnosis , Adult , Biopsy , Colonoscopy , Double-Balloon Enteroscopy , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/surgery , Humans , Male , Meckel Diverticulum/complications , Meckel Diverticulum/pathology , Meckel Diverticulum/surgery , Predictive Value of Tests , Treatment OutcomeABSTRACT
A 46-year-old Chinese woman presented with nausea, recurrent vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor at the prepyloric area on the posterior wall of the stomach. A degenerated gastrointestinal stromal tumor was suspected. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas (HPs) was confirmed. The patient had an uneventful postoperative course and was discharged 7 d after operation. The patient remains healthy and symptom-free in the follow-up of 6 mo. This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum in an adult woman.
