Clinical Endoscopy

  • 제42권5호
  • /
  • Pages.315-319
  • /
  • 2011
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

성인에서 나타난 일과성 소장 장중첩증 1예

A Case of Transient Small Intestinal Intussusceptions in an Adult

  • 조영걸 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 이태희 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 권순효 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 천강일 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김현건 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김완중 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김진오 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 이준성 (순천향대학교 의과대학 내과학교실, 소화기연구소)
  • Jo, Yeong-Geol (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Lee, Tae-Hee (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kwon, Soon-Hyo (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Cheon, Gang-Il (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kim, Hyun-Gun (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kim, Wan-Jung (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kim, Jin-Oh (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Lee, Joon-Seong (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine)
  • 발행 : 2011.05.30
⟨ 이전 논문 다음 논문 ⟩

초록

장중첩증은 장 일부가 원위부 장관 내로 유입되는 상태로 성인의 경우 전체 장중첩증의 5%에서 발생하는 드문 질환이다. 최근 영상 검사가 증가하면서 성인 소장 장중첩증의 진단이 증가하고 있고, 그 중 수술적인 치료가 불필요한 일과성 장중첩증인 경우 정확한 치료방향 정립이 무엇보다 중요하다. 성인일과성 소장 장중첩증은 대개 증상이 없고 영상 검사에서 선행병변이나 중첩 근위부의 소장 확장 소견이 보이지 않으며 특히 중첩 길이가 3.5 cm 이하일 경우 수술적인 치료 없이 보존 치료로 회복될 수 있다. 이번 증례는 성인에서 소장 장중첩증이 일시적으로 발생하였다가 대증 치료로 소실된 증례로서 문헌고찰을 통해 재조명하고자 한다.

Intussusception occurs when a segment of the bowel invaginates into the lumen of an adjacent distal segment. Intussusception in adults is a rare disease, accounting for only 5% of all cases. Asymptomatic small bowel intussusception in adults without a lead point is usually transient. When the length of the intussusception is less than 3.5 cm, it can be managed conservatively. This case was an asymptomatic small bowel intussusception without a lead point, which was discovered incidentally during an abdominal computed tomography scan. Spontaneous reduction in the intussusception was observed without any complications while maintaining conservative treatment only.

키워드

참고문헌

  1. Azar T, Berger DL. Adult intussusception. Ann Surg 1997;226:134-138. https://doi.org/10.1097/00000658-199708000-00003
  2. Nagorney DM, Sarr MG, McIlrath DC. Surgical management of intussusception in the adult. Ann Surg 1981;193:230-236. https://doi.org/10.1097/00000658-198102000-00019
  3. Reijnen HA, Joosten HJ, de Boer HH. Diagnosis and treatment of adult intussusception. Am J Surg 1989;158:25-28. https://doi.org/10.1016/0002-9610(89)90309-7
  4. Weilbaecher D, Bolin JA, Hearn D, Ogden W 2nd. Intussusception in adults. Review of 160 cases. Am J Surg 1971;121:531-535. https://doi.org/10.1016/0002-9610(71)90133-4
  5. Warshauer DM, Lee JK. Adult intussusception detected at CT or MR imaging: clinical-imaging correlation. Radiology 1999;212:853-860. https://doi.org/10.1148/radiology.212.3.r99au43853
  6. Horton KM, Fishman EK. MDCT and 3D imaging in transient enteroenteric intussusception: clinical observations and review of the literature. AJR Am J Roentgenol 2008;191:736-742. https://doi.org/10.2214/AJR.07.3741
  7. Agha FP. Intussusception in adults. AJR Am J Roentgenol 1986;146:527-531. https://doi.org/10.2214/ajr.146.3.527
  8. Felix EL, Cohen MH, Bernstein AD, Schwartz JH. Adult intussusception; case report of recurrent intussusception and review of the literature. Am J Surg 1976;131:758-761. https://doi.org/10.1016/0002-9610(76)90196-3
  9. Erkan N, Haciyanli M, Yildirim M, Sayhan H, Vardar E, Polat AF. Intussusception in adults: an unusual and challenging condition for surgeons. Int J Colorectal Dis 2005;20:452-456. https://doi.org/10.1007/s00384-004-0713-2
  10. Knowles MC, Fishman EK, Kuhlman JE, Bayless TM. Transient intussusception in Crohn disease: CT evaluation. Radiology 1989;170:814. https://doi.org/10.1148/radiology.170.3.2916035
  11. Wood BJ, Kumar PN, Cooper C, Silverman PM, Zeman RK. AIDS-associated intussusception in young adults. J Clin Gastroenterol 1995;21:158-162. https://doi.org/10.1097/00004836-199509000-00019
  12. Rea JD, Lockhart ME, Yarbrough DE, Leeth RR, Bledsoe SE, Clements RH. Approach to management of intussusception in adults: a new paradigm in the computed tomography era. Am Surg 2007;73:1098-1105.
  13. Gayer G, Apter S, Hofmann C, et al. Intussusception in adults: CT diagnosis. Clin Radiol 1998;53:53-57. https://doi.org/10.1016/S0009-9260(98)80035-4
  14. Gayer G, Zissin R, Apter S, Papa M, Hertz M. Pictorial review: adult intussusception--a CT diagnosis. Br J Radiol 2002;75:185-190. https://doi.org/10.1259/bjr.75.890.750185
  15. Merine D, Fishman EK, Jones B, Siegelman SS. Enteroenteric intussusception: CT findings in nine patients. AJR Am J Roentgenol 1987;148:1129-1132. https://doi.org/10.2214/ajr.148.6.1129
  16. Doi O, Aoyama K, Hutson JM. Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception. Pediatr Surg Int 2004;20:140-143. https://doi.org/10.1007/s00383-003-1055-9
  17. Catalano O. Transient small bowel intussusception: CT findings in adults. Br J Radiol 1997;70:805-808. https://doi.org/10.1259/bjr.70.836.9486044
  18. Lvoff N, Breiman RS, Coakley FV, Lu Y, Warren RS. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003;227:68-72. https://doi.org/10.1148/radiol.2272020455