瘻孔形成を呈した腸結核症の1例

Fistula Formation by Colon Tuberculosis, Report of a Case

要旨　患者は64歳の女性．左下腹部痛を主訴に来院．大腸内視鏡検査でS状結腸と横行結腸に粘膜下腫瘤様の隆起と潰瘍を伴う病変を認めた．生検で類上皮性肉芽腫を認め，腸結核と診断された．更に横行結腸の潰瘍にカニューレを挿入，バリウムによる注腸造影を施行したところS状結腸が造影され，腸結核による痩孔形成と診断した．rifampicinとisoniazidの投与で，左下腹部痛は改善し，瘻孔も消失した．瘻孔を形成した腸結核を大腸内視鏡での瘻孔造影で診断しえた症例を経験したので報告する．

　The patient was a 64-year-old female with the complaint of pain in her lower abdomen. Her tuberculin reaction was strongly positive with induration. Barium enema study revealed submucosal tumor at the transverse colon and irregular-shaped ulcer at the sigmoid colon. Colonoscopic examination showed a small ulcer formation around an elevated lesion at the transverse colon and a clearly differentiated ulcer at the sigmoid colon. We tried cannulating at the ulcer of the transverse colon shown by barium. We recognized fistula formation (in the sigmoid-transverse colon).

　Histological observation showed granuloma. Her symptoms improved with anti-tuberculosis agents and disappeared with fistula residual changes such as ulcer scar with a converging fold.