回腸末端に微小な腸結核病変から進展したと思われる結核性腹膜炎の1例

Tuberculous Peritonitis Probably Infected Through Small Ulcers in the Terminal Ileum, Report of a Case

要旨　患者は78歳の女性．下腹部痛，腹水を主訴として来院．腹水はリンパ球優位の滲出液で，ほかに血清CA125の上昇が認められた．結核性腹膜炎を疑い原因病変の検索のため全消化管の精査を行ったが，消化管の病変は回腸末端に微小な潰瘍を認めるのみであった．腹腔鏡検査では回盲部腸管の漿膜側に白色調の小結節が散在しており，その生検組織上，乾酪性肉芽腫が認められた．以上のことから，微細な腸結核病巣から腹膜炎を来した症例と考えられた．腹部結核は一般に，消化管に病変を有する腸結核と，消化管に病変を有さない腹膜結核に分類され，後者の感染経路は十分に解明されていない．消化管病変のない腹膜結核の中には，詳細な検索を行えば，このような微小な消化管病変が発見される可能性もあると考え報告した．

　A 78-year-old female was admitted to our hospital with complaints of abdominal pain and ascites. Her ascites was transudate and cytologically lymphocytes were predominant. Moreover, serum CA125 was markedly elevated. Gastrointestinal radiography and endoscopic examination showed scattered small ulcers in the reginal terminal ileum and a laparoscopic examination showed some tiny white nodules in the peritoneum adjacent to the terminal ileum. Histopathologically, because of caseation, necrosis was found in these nodules, and we diagnosed definitely that her peritonitis tuberculosis was infected through tuberculous enteritis. Abdominal tuberculosis is classified into tuberculous enteritis and peritoneal tuberculosis. However the route of infection of the latter has not been elucidated clearly. Considering the route of infection of the presented case, it can be said that small ulcers have been overlooked among peritoneal tuberculosis.