Ms. Zhou, 54, has been tortured by multiple intestinal polyps for more than 30 years. Since the age of 20, she has undergone four surgical open abdominal surgery removal. The insubstantial intestinal segment caused by polyps, resulting in zipper-like scars on the abdomen, also kn

54-year-old Ms. Zhou has been tortured by multiple intestinal polyps for more than 30 years. Since the age of 20, she has undergone four surgical open abdominal surgery removal. The insubstantial segment caused by polyps, resulting in a zipper-like scar on the abdomen, also known as the "zipper abdomen". Not long ago, Ms. Zhou fell ill again. Due to huge polyps, she caused intestinal obstruction and caused severe stomach pain and unable to eat. With the last glimmer of hope, she came to the endoscopic center of Zhongshan Hospital Affiliated to Fudan University for treatment. The endoscopic team cleverly used a small intestine to remove the huge polyp, and the patient is currently recovering well.

Expert introduction: Ms. Zhou suffers from "black spot-polypo syndrome". This disease is an autosomal dominant disease characterized by gastrointestinal multiple polyps, skin and mucosal pigmentation, and tendency to develop cancer. If polyps grow more than 3 cm, they will cause repeated intestinal obstruction and intussusception, and even cancer. Therefore, the patient needs to undergo surgical treatment multiple times. However, repeated open laparotomy surgery will not only cause great trauma, but also cause serious complications such as postoperative intestinal adhesion and short bowel syndrome .

Ms. Zhou's CT image showed that there was a huge space at the end of the small intestine, with a diameter of about 8*5 cm. Multiple surgeries caused intestinal adhesions, and accompanied by intussusception symptoms, routine resection cannot solve the problem safely and effectively. According to the consensus of experts on the diagnosis and treatment of small intestines (2022), for huge small intestine polyps with diameters greater than 5 cm, especially with inspinning of the small intestine, the risk of serious complications such as bleeding and perforation under endoscopy is increased accordingly, and the pros and cons are fully weighed and the treatment method is carefully selected. Professor Zhou Pinghong, director of the

Endoscopy Center, led the team to discuss the treatment plan. Although the operation is difficult, the team decided to break into the penalty area based on rich experience. The operation began at 3 pm on the 20th. It turned out that the patient's half-meter-long small intestine had been "pulled" into the colon and embedded in it. He was in a dilemma and could only remove and reduce the tumor in pieces. After the surgeon removed one-third of the tumor, the overall picture of the polyp was still not observed. The team took turns to work and operated carefully. As the tumor gradually became smaller, the lesions finally unscattered and retracted. Because the patient suffered from multiple surgeries, the patient's intestinal adhesions were caused by intestinal adhesions, and every time the entanglement surgery was followed, he needed an assistant to turn over and press his stomach. After more than 6 hours of "tug-of-war", the operation finally succeeded. Ma Lili, deputy chief physician of the

Endoscopy Center, introduced: The small intestine is an area that is difficult to reach for ordinary gastroscopy and colonoscopy , and was once considered a blind spot for gastrointestinal examination. It usually takes 5 to 15 minutes to do a gastroscopy, and 2 to 4 hours or even more for a small intestine. In addition, the small intestine wall is very thin and the blood supply is rich, making endoscopic treatment difficult. The patient's postoperative pathology indicates precancerous cancer, and timely surgery can avoid postcancerous cancer.

data shows that the endoscopic center of Zhongshan Hospital has completed more than 100 cases of various minimally invasive surgeries under small entanglement. Among them, the resection and flipped diverticulum under small entanglement is an innovative procedure, which also means that endoscopic minimally invasive can truly eliminate the last blind spot of endoscopic resection and achieve minimally invasive treatment with little trauma and good effect.

Source: Author: Gu Yong Zhong Xuan