내시경적 점막 절제술로 치료한 출혈성 과오종성 위용종
Successful Treatment of Gastric Hamartomatous Polyp with Hemorrhage by Endoscopic Mucosal Resection
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초록
과오종성 위용종은 대부분 위장의 다발성 혹은 유전적 용종증을 동반한 40대 이후의 환자들에게 나타나는 드문 질환이다. 대부분 위체부와 저부에 위치하고 작고 표면이 평활한 모양을 하고 있다. 무증상으로 우연히 발견되는 경우가 많지만, 간혹 상부위장관 출혈과 빈혈이 주증상인 경우도 있다. 치료는 크기가 작고 선천적이며 젊은 연령에서 발생하는 무경성 용종에서는 경과 관찰해 볼 수 있으나, 출혈이 동반된 거대 과오종성 용종의 경우 재출혈 위험성이 있어 내시경적 절제술이나 수술적 절제에 의한 근치적 제거가 필요하다. 저자들은 토혈을 주소로 내원한 14세 남자 환자에서 시행한 상부 위장관 내시경 검사에서 위체부와 전정부에 두개의 거대 용종을 발견하여 내시경적 점막 절제술로 치료한 위의 과오종성 용종 1예를 보고한다.
Abstract
Hamartomatous polyp is an uncommon lesion. Most of the gastric hamartomatous polyps occur in patients in their 40s because of polyposis coli. Gastric hamartomaotus polyps are usually asymptomatic, but they occasionally manifest with hematemesis or anemia. If they are congenital, then sessile polyps in children should be observed with some measurable frequency. However, many reports have revealed that if the polyp size is big and the risk of rebleeding is high, then ESD or surgical resection can be used to completely remove them. An inverted gastric hamartomatous polyp may have an early gastric cancer component. We report here on an unusual polyp in a 14-years male who presented with hematemesis. Those were about two 3 cm sized large polyps at the proximal antrum and mid body of the stomach, respectively. The polyps were successfully removed by an endoscopic mucosal resection and the lesions were diagnosed as gastric harmatomas.
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