小腸結核が疑われた1手術例

A Case Report of Strongly Suspected Intestinal Tuberculosis

　近年抗結核剤の普及により肺結核症患者が著明に減少し，腸結核症患者も減少しており，腸結核に対する関心も低下したために，腸結核の術前診断は困難になってきている¹⁾．最近術前のX線，内視鏡などの諸検査で小腸結核が強く疑われた1症例を経験したので報告する．

症　例

　患　者：35歳　女性

　主　訴：悪心　嘔吐

　既往歴：特になし．結核の既往はない

　家族歴：特になし．結核に罹患した者はいない(ただし，兄が結核療養所勤務の医師なので結核の感染機会はありうると考えられる)

　現病歴：2年前より食後に腹部膨満感を来たし，悪心を伴い1カ月に1度くらい嘔吐することがあった．1年前に微熱を伴う軽度の腹痛があった．1977年9月頃より3日に1度くらい嘔吐するようになったので，10月8日，兄の病院を受診．上部消化管X線検査にて小腸狭窄と診断された．10月31日東京医大で小腸内視鏡を施行，小腸の隆起性病変と狭窄を指摘された．その後も流動食では嘔吐しないが，普通食を摂取すると嘔吐を繰返すので，1977年11月14日，当科に入院した．

　A 35-year-old woman was admitted to our hospital, with complaints of occasional nausea and vomiting for two years. She had not a history of pulmonary tuberculosis and her chest film did not show any sign of pulmonary lesions. Roentgenographic and endoscopic examination revealed circular stenosis, some portions of the converging folds and many polypoid lesions in the proximal jejunum. Although PPD skin reaction was strongly positive, sputum and stool culture did not yield acid fast bacilli and the biopsy specimen by endoscopy did not suggest tuberculosis. She underwent jejunectomy and end-to-end anastomosis for the stenosis of the upper jejunum. The resected specimen showed one circular ulcer, four healed ulcers and many small polypoid lesions, some of which resembled the so-called “mucosal bridge”. Histological examination showed the Langhans giant cells in the mucosa of the jejunum and the noncaseous granulomatous lesions with Langhans giant cells in a mesenteric node but the Caseous granuloma and the acidfast bacilli were not found in the specimen. Therefore, the diagnosis of the jejunum was not confirmed by the histological examination, although many clinical findings strongly suggested tuberculosis.