Pedunculated Duodenal Lipoma Treated with Endoscopic Polypectomy with a Detachable Snare
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We report endoscopic polypectomy with a detachable snare in a patient with a hemorrhagic pedunculated duodenal lipoma. A 67-year-old man with a history of spinal canal stenosis was admitted to our hospital because of recurrent tarry stools and anemia. Esophagogastroduodenoscopy revealed a pedunculated submucosal tumor measuring approximately 4 cm, in the second part of the duodenum. The tumor had a slightly yellowish coloration, and longitudinal erosion was noted on the surface of the tumor. There were no significant findings in the esophagus, stomach and bulbs. Barium study revealed a pedunculated submucosal tumor measuring 40× 12 mm in the second portion of the duodenum. We judged that the submucosal tumor may have been the hemorrhagic source, and removed it by endoscopic snare polypectomy with a detachable snare. No complications occurred during endoscopic procedures. Histopathological examination revealed that the tumor was composed of mature adipose tissue in the submucosa, which was consistent with a diagnosis of lipoma. In our experience, endoscopic polypectomy with a detachable snare is useful for the treatment of hemorrhagic pedunculated duodenal lipoma.67歳の男性が黒色便を主訴に当院に紹介された．上部消化管内視鏡検査を施行し，十二指腸下行部に表面平滑で有茎性の粘膜下腫瘍を認めた．病変の色調はわずかに黄色調で，表面に縦走するびらんを認めた．低緊張性十二指腸造影検査では十二指腸下行部に透視上40 × 12mm の山田Ⅳ型の立ち上がりを呈する表面平滑な隆起性病変として描出された．各種検査の結果，出血源と判断し，留置スネアを併用した内視鏡的切除術を施行した．内視鏡的切除に関し明らかな術中及び術後の合併症は認められなかった．術後病理組織学的検索では，粘膜下層において成熟した脂肪組織の増生を認め，十二指腸脂肪腫と診断された．有茎性の十二指腸脂肪腫に対し留置スネアを併用した内視鏡的切除術は有用と考えられた．
- 2008-06-25
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