[Invagination caused by a malignant jejunal polyp--lessons from a diagnostic error].
Authors reviewed the records of a patient with a 6 year long history of severing abdominal complaints, correct diagnosis came only in the state of acute abdomen for ileus. He underwent numerous radiological exams and gastroscopies in the course of repeated check-ups in other institute. Due to these results his complaints were managed as gastro esophageal reflux. After years of ineffective therapy his parents and physician suggested him to apply for psychiatric treatment. Finally, for the symptoms and radiological results of mechanical upper small bowel obstruction he underwent urgent laparotomy. Approximately a 40 cm long jejunal invagination was found caused by a large jejunal polyp. Segmental small bowel resection was carried out. Histologic examination of the resected specimen proved Grade I. adenocarcinoma. One year after an uneventful postoperative period the patient is free of complaints and symptoms. The differential diagnosis between upper small bowel obstruction and severe vomiting of esophago-gastro-duodenal origin is relatively difficult. For this we recommend utilizing all the recent diagnostic methods in case of hesitancy or ineffective therapy.
Makay
Roland
R
Petz Aladár Megyei Oktató Kórház, Sebészeti Osztály, Gyor.
Banga
Péter
P
Pohárnok
Zsolt
Z
Oláh
Attila
A
D000006:Abdomen, Acute / Q000209:etiology* / Q000601:surgery; D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D003951:Diagnostic Errors; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D045823:Ileus / Q000209:etiology* / Q000601:surgery; D007417:Intestinal Polyps / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007443:Intussusception / Q000209:etiology* / Q000601:surgery; D007580:Jejunal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male