罕见的盲肠腺癌引起成人肠梗阻：病例报告

摘要(中文译文)

肠套叠是指一段肠管套入相邻肠段，可能导致梗阻和肠缺血。成人肠套叠通常由病理性引导点（pathological lead point, PLP）引起，由于其临床表现广泛多样，诊断具有挑战性，需要高度的临床警惕性。本病例报告描述了一例年轻患者因盲肠腺癌导致回结肠型肠套叠的罕见表现。患者为31岁女性，因间歇性腹痛进行性加重伴恶心、腹胀就诊于急诊科。患者否认发热、寒战、呕吐、便血及非意愿性体重下降。腹部及盆腔计算机断层扫描（CT）提示回盲部肠套叠及肝内两个不规则囊性肿块。结肠镜检查显示管腔内坏死性肿块后，鉴于恶性相关肠套叠的高风险，患者接受了剖腹探查术及右半结肠切除术。半结肠切除术病理结果符合结肠来源腺癌。此外，行肝活检以确认转移。术后恢复顺利，肠功能逐渐恢复，可耐受经口进食。为预期全身化疗放置了中心静脉输液港，患者被转诊至肿瘤科门诊随访，包括正电子发射断层扫描（PET）-CT显像及启动化疗。本病例强调了在以非特异性胃肠道症状就诊的年轻成人鉴别诊断中考虑结直肠恶性肿瘤的重要性。高对比度CT成像的早期诊断对于识别肠套叠、评估PLP及检测转移性疾病至关重要，而鉴于成人肠套叠的罕见性及潜在恶性病因的高可能性，及时的手术干预仍然必不可少。

Abstract

Intussusception occurs when a segment of the bowel telescopes into an adjacent segment, potentially leading to obstruction and intestinal ischemia. Intussusception in adults is likely caused by a pathological lead point (PLP), and it can be challenging to diagnose due to its broad clinical presentation, which requires a high degree of clinical suspicion. This case report describes a rare presentation of cecal adenocarcinoma in a young patient that caused ileocolic intussusception. A 31-year-old woman presented to the emergency department with progressively worsening intermittent abdominal pain, nausea, and bloating. She denied fever, chills, vomiting, hematochezia, and unintentional weight loss. Computed tomography (CT) scan of the abdomen and pelvis suggested ileocecal intussusception and two irregular cystic masses in the liver. After a colonoscopy showed a necrotic intraluminal mass, the patient underwent an exploratory laparotomy with right hemicolectomy due to the high risk of malignancy-associated intussusception. Pathology results from the hemicolectomy were consistent with adenocarcinoma of colonic origin. Furthermore, a liver biopsy was conducted to confirm metastases. The recovery was uncomplicated, with a gradual return of bowel function and tolerance of oral intake. A central venous port was placed for anticipated systemic chemotherapy, and the patient was referred for outpatient oncology follow-up, including positron emission tomography (PET)-CT imaging and initiation of chemotherapy. This case highlights the importance of considering colorectal malignancy in the differential diagnosis of young adults presenting with nonspecific gastrointestinal symptoms. Early diagnosis with high-contrast CT imaging is critical for identifying intussusception, evaluating for PLPs, and detecting metastatic disease, while prompt surgical intervention remains essential given the rarity of adult intussusception and the high likelihood of an underlying malignant etiology.

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