大腸結核の1例

Intestinal Tuberculosis, Report of a Case

要旨　症例は58歳，男性．胃癌術後の定期検査で上行結腸に横走する単発の潰瘍を認めた．周囲粘膜には潰瘍瘢痕を伴う粘膜萎縮帯はなく，回盲部の変形，回盲弁の開大も認めていなかった．しかし潰瘍は横走し，潰瘍の辺縁は整で，蚕食像などの悪性所見はなく潰瘍底は白色状で軽度凹凸を認めた．また回腸末端の腸間膜対側に潰瘍瘢痕を認めた．生検で潰瘍底の肉芽組織内に類上皮肉芽腫を認め，検体で結核菌陽性となり腸結核と確定診断した．抗結核療法を行い治療後潰瘍は著明に縮小した．本例のように無症状で発見される大腸潰瘍性病変に関して腸結核の存在を念頭に置いた診療が必要であると考えられた．

　A 58-year-old male visited our hosipital for a check-up after an operation for stomach cancer. He was found to have a simple ulcer, but, after close examination it was shown that his postoperative state was that of gastric cancer. Radiological and colonoscopic examination revealed a simple and circular ulcer in the ascending colon. The ulcer shape was clear and regular and the base of the ulcer was white and showed slight unevenness. Ulcer scar was detected in the terminal ileum but there were no malignancy indications such as erosion images and ulcer border. There were no scars or Bauhin's insufficiency. Biopsy yielded granuloma cells, so intestinal tuberculosis was diagnosed. Mycobacterium tuberculosis was detected in the biopsy specimen. We undertook antituberculosis medical treatment, and the ulcer reduced remarkably after treatment. Gastroenterologists are urged to take intestinal tuberculosis into consideration during medical examinations when a large intestinal ulcerative lesion is discovered in an asymptomatic patient.