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Ascariasis Presenting as Hematoma in the Sigmoid Mesocolon: A Case Report

구불창자간막 혈종으로 발현한 회충증: 증례 보고

  • Ji-Eun Kim (Department of Radiology Inje University Sanggye Paik Hospital) ;
  • Kyung Eun Bae (Department of Radiology Inje University Sanggye Paik Hospital) ;
  • Hyun-Jung Kim (Department of Pathology Inje University Sanggye Paik Hospital) ;
  • Byung-Noe Bae (Department of Surgery Inje University Sanggye Paik Hospital) ;
  • Ji Hae Lee (Department of Radiology Inje University Sanggye Paik Hospital) ;
  • Mi-Jin Kang (Department of Radiology Inje University Sanggye Paik Hospital) ;
  • Ji-Young Kim (Department of Radiology Inje University Sanggye Paik Hospital) ;
  • Jae Hyung Kim (Department of Radiology Inje University Sanggye Paik Hospital)
  • 김지은 (인제대학교 상계백병원 영상의학과) ;
  • 배경은 (인제대학교 상계백병원 영상의학과) ;
  • 김현정 (인제대학교 상계백병원 병리학과) ;
  • 배병노 (인제대학교 상계백병원 외과) ;
  • 이지혜 (인제대학교 상계백병원 영상의학과) ;
  • 강미진 (인제대학교 상계백병원 영상의학과) ;
  • 김지영 (인제대학교 상계백병원 영상의학과) ;
  • 김재형 (인제대학교 상계백병원 영상의학과)
  • Received : 2019.09.19
  • Accepted : 2019.10.20
  • Published : 2020.07.01

Abstract

Ascariasis is an intestinal disease caused by Ascaris lumbricoides. Most patients with ascariasis are asymptomatic; however, the presence of many larvae in the bowel can cause gastrointestinal complications, such as intestinal obstruction, obstructive jaundice, cholangitis, cholecystitis, and pancreatitis. Herein, we report a case of ascariasis presenting as hematoma and active bleeding in the sigmoid mesocolon of a 74-year-old man on computed tomography (CT). Sigmoid colon perforation was also detected on follow-up CT. Laparoscopic low anterior resection was performed; there was a large hematoma in the sigmoid mesocolon. Roundworms were microscopically identified in the mesenteric adipose tissue. The clinical and CT findings of this unusual presentation of ascariasis revealed serial complications during parasite migration from the intestinal lumen to the peritoneal cavity.

회충증은 Ascaris lumbricoides에 의하여 유발되는 장 질환이다. 대부분의 회충증 환자는 무증상이지만 장내 유충이 많은 경우에는 장 폐색, 폐쇄성 황달, 담관염, 담낭염, 췌장염과 같은 합병증이 생길 수 있다. 저자들은 컴퓨터단층촬영(이하 CT)에서 구불창자간막에 혈종과 활동성 출혈이 발생하여 회충증으로 진단된 74세 남자의 사례를 경험하였다. 이후에 환자가 시행한 CT에서는 이와 더불어 구불창자의 천공 발생이 확인되었다. 복강경을 통한 저위전방절제술이 시행되었고 구불창자간막에 큰 혈종이 있었으며 장간막 지방 조직에서 현미경적으로 회충이 확인되었다. 이러한 회충증의 드문 임상적, 영상의학적 소견은 기생충이 장관의 내강 안에서 복강 내로 이동하는 과정에서 발생한 순차적인 합병증들을 보여준다.

Keywords

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