Vnitr Lek 2020, 66(7):e39-e42 | DOI: 10.36290/vnl.2020.138

Adenokarcinom tenkého střeva diagnostikovaný pomocí video kapslové endoskopie u pacientky s celiakií: kazuistika a přehled literatury

Barbora Packová1, Lumír Kunovský1,2, Michal Eid3, Radek Kroupa1, Milan Dastych1, Michal Šenkyřík1, Tomáš Grolich2, Jakub Hustý4, Petr Jabandžiev5, Václav Kubeš6, Vladimír Procházka2, Jiří Dolina1
1 Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
2 Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
3 Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
4 Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
5 Department of Pediatrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
6 Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Celiakie je imunitně zprostředkovaná enteropatie, rozvíjející se při požití lepku u geneticky predisponovaných osob. Je spojena se zvýšeným rizikem rozvoje malignit trávicího traktu. Tyto komplikace jsou většinou diagnostikovány v pozdním stádiu, což je jedním z faktorů jejich nepříznivé prognózy. Naše kazuistika se týká ženy, jíž byla celiakie diagnostikována v 53 letech. Po 2 letech se u ní náhle rozvinula sideropenická anémie. Esofagogastroduodenoskopie ani kolonoskopie neprokázala krvácení do gastrointestinálnho traktu. Video kapslová endoskopie odhalila exulcerovanou stenózu v jejunu se známkami krvácení, před kterou kapsle retinovala. Na simultánně provedené CT enterografii nebyla infiltrace patrná. Byla provedena operační revize s resekcí infiltrace jejuna. Histologicky byl prokázán adenokarcinom tenkého střeva, vzhledem k rizikovým faktorům byla zahájena adjuvantní chemoterapie. Znalost maligních komplikací celiakie, jejich rizikových faktorů a možnosti využití moderních enteroskopických metod může přispět k časné diagnostice a zlepšení prognózy těchto onemocnění. Vzhledem k nedostatku dat a absenci doporučených postupů se léčba adenokarcinomu tenkého střeva řídí názory expertů a doporučenými postupy léčby kolorektálního karcinomu. Chirurgická resekce je jediná potenciálně kurativní léčba. U stádia II s rizikovými faktory a stádia III by měla být zvážena adjuvantní chemoterapie.

Keywords: adenokarcinom, celiakie, chirurgie, video kapslová endoskopie, tenké střevo.

Published: November 3, 2020  Show citation

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Packová B, Kunovský L, Eid M, Kroupa R, Dastych M, Šenkyřík M, et al.. Adenokarcinom tenkého střeva diagnostikovaný pomocí video kapslové endoskopie u pacientky s celiakií: kazuistika a přehled literatury. Vnitr Lek. 2020;66(7):e39-42. doi: 10.36290/vnl.2020.138.
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