십이지장으로의 유입으로 인한 부분 폐색 증상을 나타낸 위염 낭종성 용종
Partial Duodenal Obstruction Caused by an Impacted Gastritis Cystica Polyposa
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초록
위염 낭종성 용종은 위장문합술을 시행 받은 환자에서 드물게 나타나는 질환이지만, 극히 드물게 수술 받지 않은 환자에서도 발생할 수 있다. 조직학적으로 위 점막하층으로의 침범을 보이는 위선의 낭종성 확장과 과증식을 동반한 용종양의 점막 변화를 특징으로 한다. 저자들은 점점 심해지는 상복부 충만감 및 소화불량을 주소로 내원한 환자에서 시행된 상부 위장관 내시경검사에서 체부 하부에서 발생되었으나 크기 및 무게로 인하여 십이지장 구부로 유입되어 십이지장의 부분적 폐색을 일으킨 위염 낭종성 용종을 진단하였다. 크기가 매우 크며 십이지장으로 유입되어 내시경적 제거가 매우 어려웠으나, 수술적 치료가 필요 없이 안전하게 내시경적으로 절제하여 치료하였다.
Abstract
Gastritis cystica polyposa is an uncommon lesion that usually occurs at the gastroenterostomy site, but it may also develop in the non-operated stomach. This malady is characterized by polypoid mucosal changes with hyperplasia and cystic dilatation of glands that infiltrate into the submucosal layer. We report here on a case of gastritis cystica polyposa that presented as a mass impacted in the duodenum in a 63-year-old male, and this patient had been admitted for evaluation of progressive epigastric fullness and dyspepsia. Esophagogastroduodenoscopy revealed that the partial duodenal obstruction was caused by impaction of a huge polypoid mass with a stalk that originated from the lower body of the stomach. We fished out the impacted mass with a forceps catheter while holding the neck with a snare catheter. Thereafter, an endoloop was applied to the stalk of mass, and this was followed by polypectomy using a snare catheter.
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