성인에서 발생한 장중첩증의 진단과 치료
Adult Intussusception: Diagnosis and Treatment
양재도, 이민로, 김종헌, 이민로,
소속 상세정보
양재도 ( Yang Jae-Do )
전북대학교 의학전문대학원 외과학교실
이민로 ( Lee Min-Ro )
전북대학교 의과대학 외과학교실
김종헌 ( Kim Jong-Hun )
전북대학교 의학전문대학원 외과학교실
이민로 ( Lee Min-Ro )
전북대학교 의학전문대학원 외과학교실
KMID : 0356720070230060416
Abstract
Purpose: Adult intussusception occurs infrequently and differs greatly from childhood intussusception in etiology. Proper diagnostic of and surgical therapeutic methods for adult intussusception remain controversial. The aim of this study was to determine useful diagnostic modalities and proper surgical interventions in adult intussusception.
Methods: A retrospective analysis performed at Chonbuk National University Hospital identified 38 patients, aged 15 and older, with a diagnosis of intussusception from January 1991 to January 2007.
Results: There were 19 males and 19 females. The median age of the group was 44 years with a range of 20 to 80 years. The mean follow-up period was 82 months. Abdominal pain was the most common presenting complaint (89%). There were 30 small bowel intussusceptions and 8 colonic intussusceptions. A pathologic cause was identified in 79% of the patients, with 5 of 30 (17%) small bowel and 4 of 8 (50%) large bowel lesions being malignant. A preoperative diagnosis was made accurately in 25 of 38 (66%) patients. The diagnostic rates of pre-operative radiological methods were 77%, 60%, 79%, and 100% for barium enema, ultrasonography, abdominal computerized tomography, and both ultrasonography and abdominal computerized tomography, respectively. Operative treatment consisted of manual reduction only in 6 small bowel (20%) and 1 large bowel intussusception (12%), bowel resection after manual reduction in 8 small bowel (27%) and 2 large bowel intussusceptions (24%), and resection alone in 16 small bowel (53%) and 5 large bowel intussusceptions (64%).
Conclusions: Both ultrasonography and abdominal computerized tomography are the most useful diagnostic modalities. Colonic intussusception should be treated with en-bloc resection without reduction due to the high incidence of malignancy. However, manual reduction only, bowel resection after reduction, and bowel resection alone can be chosen selectively in cases of small bowel intussusception. J Korean Soc Coloproctol 2007;23:416-419
키워드
장중첩증;성인;진단;치료
Intussusception;Adult;Diagnosis;Treatment
원문 및 링크아웃 정보
등재저널 정보