The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Asymptomatic Small Bowel Lymphoma Discovered Incidentally Following Ileal Intubation During Screening Colonoscopy

대장내시경 시행 중 회장 삽관을 통해 우연히 발견된 무증상의 소장 림프종

  • Kim, Eun Hee (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Rae Seok (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Hu, Joo Yeun (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Yoon Seok (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Gyo Hui (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Oh, Jung Hwan (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Roh, Sang Young (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 김은희 (가톨릭대학교 의과대학 내과학교실) ;
  • 이래석 (가톨릭대학교 의과대학 내과학교실) ;
  • 허주연 (가톨릭대학교 의과대학 내과학교실) ;
  • 최윤석 (가톨릭대학교 의과대학 내과학교실) ;
  • 김교희 (가톨릭대학교 의과대학 내과학교실) ;
  • 오정환 (가톨릭대학교 의과대학 내과학교실) ;
  • 노상영 (가톨릭대학교 의과대학 내과학교실)
  • Received : 2013.04.26
  • Accepted : 2013.08.26
  • Published : 2014.01.01
⟨ Previous Next ⟩

Abstract

Primary lymphoma of the small intestine is commonly diagnosed after serious complications, such as bowel perforation and bleeding. It results from vague symptoms and the lack of routine screening programs due to low prevalence. Ileal intubation can be used for screening and diagnosis of various small intestinal diseases. However, the value of routine terminal ileum intubation during colonoscopy remains controversial because of its low diagnostic yield. In Korea, there has been no report of asymptomatic primary lymphoma of the small intestine discovered through ileal intubation during colonoscopy. Thus, we report a case of asymptomatic primary lymphoma of the small intestine diagnosed incidentally through terminal ileum intubation during screening colonoscopy, and we review the literature on small intestinal lymphoma and the value of routine ileal intubation.

원발성 위장관 림프종은 흔하지 않으며 특히 소장 림프종의 경우는 드문 질병이다. 낮은 질병 빈도로 인하여 충분한 연구 결과가 부족한 실정이고 이로 인해 확실하게 정립된 치료 방법이 없다. 비특이적인 임상 증상으로 인해 진단이 늦어지는 경우가 흔하며 즉시 수술적 치료를 요하는 합병증이 발생하여 진단되기도 한다. 대장 내시경을 시행하면서 통상적 회장 삽관으로 소장 림프종이 진단되는 경우들이 보고되었고 이번 증례처럼 특이한 증상이 없는 환자에서도 통상적 회장 삽관으로 진단되기도 하여 대장 내시경 검사에서 회장 삽관을 고려해야 한다. 저자들은 통상적 회장 삽관을 통해 우연히 무증상의 소장 림프종을 진단한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011;17:697-707. https://doi.org/10.3748/wjg.v17.i6.697
  2. Beaton C, Davies M, Beynon J. The management of primary small bowel and colon lymphoma: a review. Int J Colorectal Dis 2012;27:555-563. https://doi.org/10.1007/s00384-011-1309-2
  3. Kennedy G, Larson D, Wolff B, Winter D, Petersen B, Larson M. Routine ileal intubation during screening colonoscopy: a useful maneuver? Surg Endosc 2008;22:2606-2608. https://doi.org/10.1007/s00464-008-9843-x
  4. Jeong SH, Lee KJ, Kim YB, Kwon HC, Sin SJ, Chung JY. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol 2008;23:51-55.
  5. Honda H, Kume K, Shimada M, Yamasaki T, Yoshikawa I, Otsuki M. Primary small intestinal lymphoma without symptom diagnosed by colonoscopy. J Gastroenterol Hepatol 2003;18:605-607. https://doi.org/10.1046/j.1440-1746.2003.03043.x
  6. Donnellan F, Moran S, Patchett SE. An incidentaloma at ileal intubation. World J Gastrointest Endosc 2011;3:228-230. https://doi.org/10.4253/wjge.v3.i11.228
  7. Iturrino J, Sweetser S, Baron TH. Localized primary ileal lymphoma found on colonoscopic examination. Am J Gastroenterol 2012;107:955-956. https://doi.org/10.1038/ajg.2012.58
  8. Chung GO, Kang DB, Oh JT, Jo HJ. Primary malignant lymphoma of the terminal ileum causing intussusception in adults. J Korean Surg Soc 2007;72:244-249.
  9. Koo JE, Ko OB, Lee DB, et al. Primary gastrointestinal diffuse large B-cell lymphoma: a clinical analysis of 76 patients with special application of International Prognostic Index for survival. Korean J Med 2007;72:11-19.
  10. Iacopini G, Frontespezi S, Vitale MA, et al. Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line. Gastrointest Endosc 2006;63:250-256. https://doi.org/10.1016/j.gie.2005.09.029
  11. Choung RS, Jeen YT, Kim YS, et al. A case of small intestinal Burkitt's lymphoma in an adult. Korean J Gastrointest Endosc 2001;22:435-439.