腸結核診断の現状―最近の当科経験例を中心に

Present Status in the Diagnosis of Intestinal Tuberculosis

要旨　腸結核診断の現状を明らかにするために，平成以降（1989年以降）に当科で経験した活動性腸結核6例の臨床成績を検討した．5例は50歳以上で，2例は無症状で大腸がん集検により拾い上げられた．肺結核の既往，初診時活動性病変はそれぞれ1例にみられたのみで，2/3の症例は原発性腸結核と思われた．ッベルクリン反応が陽性を示したのは半数のみだった．X線的には大腸癌，Crohn病との鑑別を要したのが1例ずつあった．3例で病変部から結核菌を検出できたが，乾酪壊死は1例にも証明できなかった．他の3例も形態学的特徴と治療効果から確診とした．今後も結核罹患率低下の鈍化が続くことが予想され，腸結核の存在を常に念頭に置いて診療に当たる必要がある．

　To clarify the present status in the diagnosis of intestinal tuberculosis, we analyzed clinical data and radiographic, endoscopic and histologic findings of six patients with intestinal tuberculosis who visited our hospital during the last six years. All but one were more than 50 years old. Two cases had no symptoms, but were picked up by a positive fecal occult blood test. One patient had a past history of pulmonary tuberculosis and another one had active pulmonary tuberculosis on admission. As regards the Mantoux test, only three patients showed a positive reaction. Radiographically, it was difficult to differentiate this disease from colonic cancer or Crohn's disease in two cases. In three cases tubercle bacilli were proven in biopsy specimens obtained from active lesions, but no Gaseous granulomas could be observed. The remaining three cases were diagnosed as intestinal tuberculosis by the morphological characteristics and the effects of anti-tuberculosis therapy. In Japan, it is presumed that the recent slowing of the decrease in the incidence of tuberculosis will continue for a while. Gastroenterologists are urged to take intestinal tuberculosis into consideration during medical examinations.