DM HTN Pul Tbc Surgery history Malignancy history
과거력 DM/ HTN/ Pul. Tbc (-/-/-) Surgery history (-) Malignancy history (-) Medication : none 가족력 N-S 사회력 Alcohol (+) : 1 bottle of soju per day (≥ 20 years) Smoking (+) : 40 pack years
< Review of Systems > HEENT/ Respiratory/ Cardiovascular/ Genitourinary/ Musculoskeletal/ Skin : none Gastrointestinal anorexia (-), nausea (-), vomiting (-) diarrhea (-), constipation (-), abdominal pain (-), melena (-), hematochezia (-), hematemesis (-) < Physical Examination > V/S 124/77 mm. Hg - 83/min - 18/min – 36. 5 °C BWt. 83 kg Height 185 cm BMI 24 kg/m 2 General appearance : healthy-looking appearance M/S : alert mental status HEENT/ Chest/ Back & Extremities : N-S Abdomen : soft & flat abdomen normoactive bowel sound palpable mass (-) hepatomegaly (-), splenomegaly (-) abdominal T/RT (-/-)
< Initial lab. Data > CBC, chemical battery, electrolyte battery : WNL < Initial chest PA >
AP CT
Problem list #1. Ileal mass Initial assessment and plans #1. Ileal mass A) Ileal hemangioma, most likely Ileal adenocarcinoma, less likely P) Double balloon enteroscopy If needed, consider operation
Hospital day #4 Operation : laparoscopic small bowel resection and anastomosis
Pathologic finding
Final Diagnosis Ileal cavernous hamangioma --> surgical removal
Solitary hemangioma of the small intestine • GI hemangioma : only 0. 05% of all intestinal neoplasm • Congenital hamartomatous lesions originating from embryonic sequestrations of mesodermal tissue • Midjejunum : the most common location • Associated diseases : Tuberous sclerosis, Osler. Weber-Rendu disease, Maffucci syndrome, the blue rubber-bleb nevi syndrome
• Only a few case reports • Microscopically : cavernous type > • Manifestations : overt rectal bleeding, abdominal pain, chronic anemia, intussusception, SB obstruction, intramural hematoma, and perforation • Diagnostic tools : angiography, nuclear scans, CT enteroclysis, enteroscopy, and capsule endoscopy
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