A CASE OF INTUSSUSCEPTION OF THE DUODENUM CAUSED BY A TUBULOVILLOUS ADENOMA

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A 64-year-old woman was admitted to the hospital because of repeated periumbilical, pain. Fluoroscopic examination of the duodenum visualized a 6×4cm pedunculated polyp in the descending portion of the duodenum of which peduncle existed in the vicinity of the superior flexure. Duodenoscopy revealed no peduncle. Biopsy indicated adenoma. CT revealed a tumor of lamellar structure presenting an incomplete circumference proliferation with a low-density area at the descending portion of the duodenum. Gastroduodenal angiography showed a homogenous slight tumor stain. Based on these findings, the patient was diagnosed as having the peduculated adenoma in the upper region of the duodenum that headed intussusception, and was operated on. On laparotomy, the superior portion of the duodenum prolapsed into the descending portion causing the intussusception, and a tumor was palpated in the head. The intussusception was relieved and the duodenum was incised, when it was revealed that the tumor was Yamada's type III polyp and the peduncle-like existence was duodenal mucosa pulled by the polyp. The polyp was excised. Histopathologically it was tubulovillous adenoma without coexistence of any malignantcy. Postoperative course has been uneventful, as of 2 years and 6 months after the operation.
日本臨床外科学会の論文