著明な狭窄を伴う全周性の潰瘍を呈した腸結核の1例

Intestinal Tuberculosis Presenting with Circumferential Deep Ulcers, Complicated by Severe Colonic Stenosis, Report of a Case

要旨　患者は20歳代，女性．腹痛，下痢，微熱を主訴に来院した．注腸X線検査では，回盲部に著明な狭窄を呈した．下部内視鏡検査で狭窄部に全周性の潰瘍を認めた．潰瘍底は顆粒状で白苔はみられず，潰瘍辺縁になだらかな周堤を伴っていた．潰瘍肛門側辺縁には発赤が認められた．病変部からの生検培養と便培養にて結核菌を認め，また肺結核も認められたため，続発性腸結核と考えられた．抗結核療法後，腸閉塞を呈し右半結腸切除術が施行された．通常腸結核の潰瘍は浅いが，本症例はUl-IIIからUl-IVの深い全周性潰瘍を呈しており，画像所見から腸結核を疑うことは難しかった．本例は深い潰瘍と膿瘍を形成することで，筋層から漿膜下層にかけて強い線維化を来したために，腸壁の肥厚と著明な狭窄を来したと考えられた．

　The patient in her late 20's was admitted to our hospital, complaining of abdominal pain, diarrhea and fever. Barium-enema showed severe colonic stenosis at the ileocecal portion. Colonoscopy showed luminal narrowing with circumferential deep ulcers. These findings had been difficult to diagnose as malignant lymphoma or chronic inflammation due to some sort of infection. Cultures of stool and biopsy specimens enabled the recognition of Mycobacterium tuberculosis. A right hemicolectomy was performed under the diagnosis of ileus, after anti-tuberculosis therapy. There were huge deep ulcers with inflammatory wall thickening in the resected material. Histological examination revealed caseous necrosis with granuloma and abscess..

　We reported a case of intestinal tuberculosis with circumferential deep ulcers and marked wall thickening that had been difficult to diagnose endoscopically.