Ultrasound Journal 5: Hidden World Under the Mucosa - ??? ??? ?? Gastric Wall? Ectopic Pancreas ??
2022-11-15
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- ??? ??? ???? ? gastric window? ?? ?? ??? ??? ?? gastric wall? ?? ?? ?? ??? ??? ???? ??? ??? ??? ??? ? ????.
- Color Doppler? ectopic pancreas ??? ??? ???? ?? ??? ? ????.
Case Description:
32? ????? 1? ?? ??? epigastric discomfort ??? ?? ???????. ??? ?? ?? ?? ??? ????, ??? ????(???)?? gastrointestinal malignancy ? ??? ???, ?? ????? ??? ?????.
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2018?, ??? ? ??? ??? ?? chronic gastritis, ??? gastric antrum?? lesser curvature? submucosal bulging mass? ??? ??? ?????. (?? 1).
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2019?, ??? ??? ???? ??? gastric antrum?? lesser curvature? submucosal bulging mass? ?????? submucosal ectopic pancreas? ???????. (?? 2)
Gastric window? ?? ?? ??? ??:
??? ???(instant gastrointestinal ultrasound aid) 500mL? ?? ???? ?? ? ??? ??? ?????. Gastric wall? ??? ???? ?? ??? ???? ?? ??????, Gastric antrum? lesser curvature? submucosal layer??? ? 1.36cm×0.87cm ??? ?? ??? hypoechoic mass? ???????. ??mass? ????? ????? ????, ???? ?? ???? ???????.
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???, mass? ??? ???? ?? ??? ?????, mass ????? ???? echogenicity ? ???????.(?? 3).
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CDFI(Color Doppler Flow Imaging)? ?? ?? ??? ???? ??? mass? ??? ???? ??? ? ??? ???????. (?? 4) ??? ???? ?(stomach)? submucosal ??? ?????, ectopic pancreas? ???????.
Procedure:
??? ?? ??? ??? ?? contraindication ?? ??? ????, ???? endoscopic submucosal dissection(ESD)? ??.
Postoperative diagnosis:
Mucosa?? ??? ectopic pancreatic tissue? ??? gastric mucosa? ??? ???? ??? ??..
Discussion:
Aberrant pancreas ?? accessory pancreas? ??? ectopic pancreas? ??? ?? ?????. Ectopic pancreas ??? 90%? gastrointestinal tract? ???? ?????, jejunum(??), ileum(??), Meckel diverticulum(??? ???), gallbladder(??), bile duct(??) ? ?? ????? ?????. Ectopic pancreas ??? ???? ????? ????, ?? ?? ???? ?????, ??? ?????? ?????. ??? ????? ???? ??? ?? ????, ?? ???? gastric cavity? ???? ????. ?? ????? ??? 2.0cm????? ????? ??? ??? ????.
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?Ectopic panaceas? ?? ?? ??? acini? pancreatic duct? ??? ?? ?????. ???? ??? isoechoic?? ??? hypoechoic???. ??????? ??? ???? ???? medium ?? hypoechoic? substantial mass? ????, ??? ????? ????? echogenicity? ??? ???, mass ??? gastric wall? ???? well-layered? ??? ???????. Submucosa??? ectopic pancreas? ?? digestive tract? central-duct ???? ?? ??? umbilical depression? ?????.
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??? ?? ?? ? ??? ?? mass ??? mucosal layer, mucosal muscle layer, muscle layer ?? serosal layer? ????? ??? ?? ??? ??????. Submucosal? ?? ???? hypoechoic????, ??? ??? central depression? ???, gastric peristaltic wave? ?? ??? ???? mass??? ???? ??? mucosal fold? ??? ? ?? sound attenuation? ?????. ???, ???? gastric wall? ????? ?? ???? ???? ?? peristaltic wave? ???? mass? ??? ??? ??? ???? ????. Ectopic pancreatic tissue ?? ?? ??? ??? ??? ?? ???? ??, Color Dopler ultrasound (CDUS)? mass? ????? ?? ?? ??? ?? gastric ectopic pancreas? ?? ??? ?? ??? ?? ? ???, ???? ??? ??? ? ??? ???????.
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? ??? ?? submucosal ???? ??? gastric leiomyoma(?????), mesenchymoma(???)? ????? ???. ?? ???? ?? ??? ? gastric window? ?? ?? ?? ???? ???? gastric window? ?? layer? ??? ???? ???? ??? ??? ??? ?? ?? ??? ?? differential diagnosis? ??? ? ????.