Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Inflammatory Pseudotumor Causing Small Bowel Obstruction in a Patient with AIDS

후천성면역결핍증 환자에서 소장 폐쇄를 유발한 염증성 가성종양

  • Kim, Hyun-Soo (Department of Internal Medicine, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Cha, Jae-Myung (Department of Internal Medicine, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Lee, Joung-Il (Department of Internal Medicine, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Joo, Kwang-Ro (Department of Internal Medicine, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Jung, Hyun-Joon (Department of Internal Medicine, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Lee, Chi-Hoon (Department of Internal Medicine, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Lim, Sung-Jig (Department of Pathology, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine) ;
  • Na, Ki-Yong (Department of Pathology, Gang Dong Kyung Hee University Hospital, Kyunghee University College of Medicine)
  • 김현수 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 차재명 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 이정일 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 주광로 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 정현준 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 이치훈 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 임성직 (경희대학교 의과대학 강동경희대학교병원 병리학교실) ;
  • 나기용 (경희대학교 의과대학 강동경희대학교병원 병리학교실)
  • Published : 2011.04.30
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Abstract

Small bowel obstructions are most commonly caused by adhesions, hernias, neoplasms or inflammatory stricture. Inflammatory pseudotumors are an uncommon cause of small bowel obstruction, even in a patient with acquired immunodeficiency syndrome (AIDS). We have experienced a case of small bowel obstruction caused by an inflammatory pseudotumor in a 38-year old male with AIDS. Abdominal computed tomography showed small bowel obstruction due to jejunal annular wall thickening. Surgical laparotomy showed a non-specific granulomatous inflammatory mass that could not fulfill any diagnostic criteria for a specific disease. This report describes our findings of small bowel obstruction due to an inflammatory pseudotumor and discusses the differential diagnosis of inflammatory pseudotumor in AIDS patients.

소장 폐쇄는 흔히 유착, 탈장, 악성 종양, 염증성 협착에 의해 유발된다. 염증성 가성종양은 후천성면역결핍증 환자에서도 역시 소장 협착의 매우 드문 원인이다. 저자들은 38세의 후천 성면역결핍증 남자에서 염증성 가성종양에 의한 소장 폐쇄를 경험하였다. 복부 전산화단층촬영 검사에서 공장의 윤상 협착에 의한 소장 폐쇄가 관찰되었으며, 시험 개복술에서 어떤 특정 질환의 진단 기준에는 합당하지 않은 비특이적 육아종 염증성 가성종양을 확인하였다. 이번 증례 보고에서는 후천성면역결핍증 환자에서 발생한 염증성 가성종양에 의한 소장 폐쇄에 대해 기술하고, 후천성면역결핍증 환자에서 염증성 가성 종양의 감별진단에 대해 고찰하였다.

Keywords

References

  1. Silva AC, Pimenta M, Guimaraes LS. Small bowel obstruction: what to look for. Radiographics 2009;29:423-439. https://doi.org/10.1148/rg.292085514
  2. Cosme A, Pardo E, Felipo F, Iribarren JA. Abdominal pain in a HIV-infected patient. Rev Esp Enferm Dig 2005;97:196-210.
  3. Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004;120:305-315.
  4. Kim YS, Kim YH, Lee KM, et al. Diagnostic guideline of intestinal tuberculosis. Korean J Gastroenterol 2009;53:177-186.
  5. Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002;97:1446-1451. https://doi.org/10.1111/j.1572-0241.2002.05686.x
  6. Cappell MS, Hassan T, Rosenthal S, Mascarenhas M. Gastrointestinal obstruction due to Mycobacterium avium intracellulare associated with the acquired immunodeficiency syndrome. Am J Gastroenterol 1992;87:1823-1827.
  7. Havlik JA Jr, Horsburgh CR Jr, Metchock B, Williams PP, Fann SA, Thompson SE 3rd. Disseminated Mycobacterium avium complex infection: clinical identification and epidemiologic trends. J Infect Dis 1992;165:577-580. https://doi.org/10.1093/infdis/165.3.577
  8. Wilcox CM, Schwartz DA. Symtomatic CMV duodenitis. An important clinical problem in AIDS. J Clin Gastroenterol 1992;14:293-297. https://doi.org/10.1097/00004836-199206000-00006
  9. Han KJ, Jung IS, Kim CK, et al. A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma. Korean J Intern Med 1998;13:143-146. https://doi.org/10.3904/kjim.1998.13.2.143
  10. Wisser J, Zingman B, Wasik M, Duva-Frissora A, Beazley R, McAneny D. Cytomegalovirus pseudotumor presenting as bowel obstruction in a patient with acquired immunodeficiency syndrome. Am J Gastroenterol 1992;87:771-774.
  11. Gumbs MA, Girishkumar H, Yousuf A, Levy L, Patel M, Narasimha V. Histoplasmosis of the small bowel in patients with AIDS. Postgrad Med J 2000;76:367-369. https://doi.org/10.1136/pmj.76.896.367
  12. Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol 2001;33:267-282. https://doi.org/10.1097/00004836-200110000-00004
  13. Friedman SL. Kaposi's sarcoma and lymphoma of the gut in AIDS. Baillieres Clin Gastroenterol 1990;4:455-475. https://doi.org/10.1016/0950-3528(90)90012-6
  14. Hatoum OA, Binion DG, Phillips SA, et al. Radiation induced small bowel "web" formation is associated with acquired microvascular dysfunction. Gut 2005;54:1797-1800. https://doi.org/10.1136/gut.2005.073734
  15. Fortun PJ, Hawkey CJ. Nonsteroidal antiinflammatory drugs and the small intestine. Curr Opin Gastroenterol 2005;21:169-175. https://doi.org/10.1097/01.mog.0000153314.51198.58
  16. Van Buren G 2nd, Teichgraeber DC, Ghorbani RP, Souchon EA. Sequential stenotic strictures of the small bowel leading to obstruction. World J Gastroenterol 2007;13:5391-5393. https://doi.org/10.3748/wjg.v13.i40.5391
  17. Freeman HJ. Multifocal stenosing ulceration of the small intestine. World J Gastroenterol 2009;15:4883-4885. https://doi.org/10.3748/wjg.15.4883
  18. Aboulafia DM. Inflammatory pseudotumor causing small bowel obstruction and mimicking lymphoma in a patient with AIDS: clinical improvement after initiation of thalidomide treatment. Clin Infect Dis 2000;30:826-831. https://doi.org/10.1086/313768