新英格兰NEJM:人体内长鸡蛋

新英格兰杂志发表了一篇报道:患者体内长了一个“鸡蛋”。

一位62岁的老年男性因20多年的尿频来诊。体格检查和实验室检查无特殊发现。腹部和骨盆CT显示8.5cm大小的包块,中央出现钙化(图A红色箭头所示)。该包块对膀胱形成压迫(图A蓝前头所示)。腹腔镜检查发现包块活动良好,表面光滑,质硬,大小约9.5cmX7cm,重约220g(图B和图C)。对包块进行切开发现其可分为数层(为了清楚的显示边缘,对外层进行了绿色染色)(图D)。组织病理学检查发现包块主要是呈分层排列的非细胞成分(纤维组织),还有类蛋白样物质和纤维素样坏死物质,周围是钙化圈。该结果与腹腔游离体一样,一般认为是由肠扭转,肠血管梗塞以及游离的肠脂垂等形成的纤维化团块。这种团块小的时候常常无明显自觉症状,但是随着团块的增大,可以导致压迫周围组织,从而引起躯体症状,如肠梗阻,尿潴留或者尿频(本例患者就是出现的尿频)。经过手术取出包场后,患者的尿频症状痊愈。



Peritoneal Loose Body


A 62-year-old man presented for evaluation of a history of urinary frequency of more than 20 years. The physical examination and laboratory findings were unremarkable. Computed tomography of the abdomen and pelvis revealed an 8.5-cm midline mass with central calcification (Panel A, red arrow) superior to and compressing the bladder (Panel A, blue arrow). Laparoscopy revealed a free-floating, smooth, firm, rubbery mass measuring 10 cm by 9.5 cm by 7.5 cm and weighing 220 g (Panels B and C). The sectioned specimen included several layers; green ink was used to delineate section margins (Panel D). Histologically, the mass contained predominantly acellular, laminated, fibrous tissue; centrally, the specimen contained proteinaceous material with fibrinoid necrosis, surrounded by a ring of calcification. The findings were consistent with a peritoneal loose body, a formation that is thought to result from torsed, infarcted, and detached epiploic appendages that transform into fibrotic masses. Such masses are often asymptomatic when they are small, but they can be large enough to cause extrinsic compression that is associated with bowel obstruction, urinary retention, or (as in this patient) urinary frequency. The patient's urinary frequency resolved immediately after the surgical removal of the mass.

原文链接:http://www.nejm.org/doi/full/10.1056/NEJMicm1316094

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