A rare cause of upper gastrointestinal bleeding; giant lesion in esophagus!

Yıl 2022, , 854 - 858, 01.10.2022

Mehmet İbiş , Mustafa Ergin , Ali Çelik , Güner Kılıç Kaan Talay

https://doi.org/10.31362/patd.1037286

Öz

Fibrovascular polyps are one of the benign esophageal tumors and rare gastrointestinal bleeding reasons. They are mostly located in the proximal esophagus. Swallowing and breathing problems, mass feelings, discomfort when swallowing, nausea, weight loss, and a persistent cough are the most common symptoms. Endoscopic resection or esophagectomy are the two main options for treatment. A 60-year-old male patient was admitted for epigastric pain and melena. Endoscopy showed a 15-centimeter-long pedunculated polyp originating from the proximal esophagus and extending to the cardia, narrowing the lumen. The lesion was excised with multiple incisions using surgical ligature and an endoscopic knife after endoscopic ultrasonography and computed tomography examinations. The lesion was too big to be endoscopically removed from the esophageal lumen. Therefore, nearly a 3-4 cm incision was made on the abdomen skin. Under the guidance of the endoscope, the polyp was removed from the incision region using a clamp. Following hemostasis, the stomach was reconstructed and the procedure ended. No problems occurred. The patient is protected from major surgical and operational risks with endoscopic removal of large polyps. Patients who are candidates for endoscopic resection should consider it.

Anahtar Kelimeler

Gastrointestinal bleeding, fibrovascular polyp, endoscopic treatment

Nadir bir üst gastrointestinal kanama nedeni; özofagusta dev lezyon!

Öz

Gastrointestinal kanamanın nadir nedenleri arasında yer alan ve benign özofagus tümörleri arasında bulunan fibrovasküler polipler çoğunlukla proksimal özofagustan köken alır. Yutma ve nefes almada zorluk, yutma sırasında hissedilen kitle hissi ve ağrı, bulantı hissi, kilo kaybı, inatçı öksürük ve kanama gibi şikâyetlere neden olan kitlelerdir. Tedavi endoskopik rezeksiyon veya özofajektomidir. 60 yaşında erkek hasta melena şikâyeti ile başvurdu. Endoskopide ön kesici dişlerden itibaren 17. cm'den başlayarak kardiaya uzanan ve lümeni daraltan 15 cm uzunluğunda pedinküle polip görüldü. Endoskopik ultrasonografi ve bilgisayarlı tomografi incelemelerinin ardından lezyon, cerrahi ligasyon ve endoskopik knife ile çoklu kesi yapılarak rezeke edildi. Lezyon büyük olduğu için özofagus lümeninden çıkarılamadı, kardiadan 3-4 cm'lik bir kesi yapıldı. Polip endoskop eşliğinde klemp ile kesi alanından çıkarıldı. Daha sonra mide onarıldı ve hemostazın ardından operasyon sonlandırıldı. Herhangi bir komplikasyon olmadı. Dev poliplerde endoskopik rezeksiyon, hastayı majör cerrahi ve operatif risklerden korur. Uygun hastalarda endoskopik rezeksiyon düşünülmelidir.

Anahtar Kelimeler

Gastrointestinal kanama, fibrovasküler polip, endoskopik tedavi

Kaynakça

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