コンテンツメニュー

Surgical resection for hemorrhage in a case of brunner's gland hyperplasia that had increased over the course of 5 years

山口医学 Volume 62 Issue 1 Page 43-48
published_at 2013-02-01
B030062000107.pdf
[fulltext] 4.07 MB
Title
5年の経過で増大し出血を来したBrunner腺過形成の一切除例
Surgical resection for hemorrhage in a case of brunner's gland hyperplasia that had increased over the course of 5 years
Creators Shiratsuki Shogo
Affiliate Master Yamaguchi University
[kakenhi]15501 grid.268397.1
Creators Okamoto Takeshi
Creators Hamabe Kouichi
Creators Senyo Manabu
Creators Nishikawa Jun
Creators Hashimoto Noriaki
Creators Yoshino Shigefumi
Creators Sakaida Isao
Source Identifiers
Creator Keywords
Brunner腺過形成 粘膜下腫瘍 十二指腸
Brunner腺過形成は主に十二指腸球部に生じる良性疾患であるが,出血や消化管閉塞を来すことも報告されている.今回我々は5年に渡り内視鏡による経過観察を行い,最終的に出血を来したため手術を行ったBrunner腺過形成の一例を経験したため報告する. 症例は50歳代男性.検診を契機に十二指腸球部に長径15mm程度の粘膜下腫瘍様の隆起性病変を指摘され,当科に紹介となった.生検から腫瘍性病変の可能性は低いと判断し,年1回の上部消化管内視鏡検査(EGD)にて経過観察されていた.しかし,病変は年々増大し30mm大となったため,精査目的で当科入院となった.入院の2~3日前から黒色便が認められたため,EGDを施行したところ,経過観察中の病変表面にびらんが生じ,出血が認められた.病変が増大傾向にあることと再出血の可能性を考慮し,切除の適応と判断した.内視鏡的切除は困難であったため,外科的に十二指腸部分切除術が施行された.摘出標本の病理組織診断にてBrunner腺過形成と診断された.本症例はBrunner腺過形成の出血に至るまでの形態変化を経時的に追えた点で貴重と考えられた.
Brunner's gland hyperplasia, a benign disease occurring mainly in the duodenal bulb, also causes hemorrhage or gastrointestinal obstruction. We report a case of Brunner's gland hyperplasia followed with endoscopy over 5 years, resulting in surgery due to hemorrhage. A man in his 50’s was referred to us after his medical checkup indicated a submucosal tumor-like protruding lesion with a diameter of approximately 15 mm in the duodenal bulb. Biopsy indicated the low possibility of a neoplastic lesion, and he was followed with esophagogastroduodenoscopy(EGD)annually. However, lesion size had increased year by year to 30 mm, and the patient was admitted to our department for further examination. Melena was observed from 2 to 3 days before admission; therefore, we performed EGD, which revealed the presence of erosion and hemorrhage on the lesion surface. We thought the lesion would tend to grow and that hemorrhage would likely recur, and we judged that the patient met the criteria for resection. Because endoscopic resection was difficult, we resected the lesion by partial duodenectomy. The histopathologic diagnosis was Brunner's gland hyperplasia. This case was valuable because morphological changes leading to hemorrhage in this case of Brunner's gland hyperplasia could be observed chronologically.
Subjects
医学 ( Other)
Languages jpn
Resource Type journal article
Publishers 山口大学医学会
Date Issued 2013-02-01
File Version Version of Record
Access Rights open access
Relations
[ISSN]0513-1731
[NCID]AN00243156
Schools 医学部