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A Case of Multiple Ulcers of the Small and Large Intestine Difficult to Get a Histological Diagnosis of Tuberculosis A. Matsuda 1 , K. Takeda 1 , M. Taguchi 1 , R. Yatani 2 , H. Umemoto 3 , T. Matsumoto 4 , M. Yoshioka 5 1Dept. of Radiology, Mie University School of Medicine 2Dept. of Pathology, Mie University School of Medicine 3The 2 nd. Dept. of Internal Medicine, Mie University School of Medicine 4Mie Nursing College 5Dept. of Surgery, Toyama Hospital pp.1223-1229
Published Date 1978/9/25
DOI https://doi.org/10.11477/mf.1403107507
  • Abstract
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 A 51-year-old man was admitted to Toyama Hospital complaining of periodic episodes of lower abdominal pain for four years. He had anemia and hypoproteinemia.

 Stool examination for occult blood was strongly positive. Cultures of stool for tubercle bacillus were negative and there were no abnormal findings in the chest roentgenogram.

 Double contrast radiogram of gastrointestinal tract showed girdle ulcers, circular narrowings and inflammatory polyps in the ileum and circular narrowing, atrophic mucosa, pseudodiverticuli and multiple ulcer scars in the ascending colon.

 These X-ray findings strongly suggested intestinal tuberculosis. Partial ileocolectomy was performed.

 The resected specimen showed multiple girdle, rounded, or irregular-shaped ulcers in the lower ileum and narrowing, shortening with atrophic mucosa and healed ulcers in the ascending colon, The terminal ileum measuring about 30 cm in length had no ulcerative lesions.

 Histologically, the ulcers of the ileum were confined within the submucosa (Ul-Ⅱ) and no evidence of specific granulomatous changes was obtained in these lesions.

 There were also no proliferative mucosal changes among the ulcers. It was therefore thought that the ileal lesions were consistent with the so-called non-specific multiple ulcers of the small intestine proposed by Okabe and Yao.

 On the other hand, in the ascending colon, some epitheloid cell granulomas were observed in the submucosa but no tendency to caseation necrosis was seen. Therefore, the final histological diagnosis of this lesion could not be made in spite of its typical macroscopic apearance of tuberculosis. Shirakabe reported that the difference between macroscopic (including X-ray) findings and histological appearance depended upon the process of the lesion, and he emphasized the superiority of the macroscopic pictures in diagnosing intestinal tuberculosis.

 According to his statement, this lesion might be consistent with tuberculosis. However, histologically it might be diagnosed as non-specific granulomatous colitis.

 We thought there might be two ways to interprete the findings of this case. It was as follows;  (1) tuberculosis of the ascending colon complicated with non-specific multiple ulcers of the ileum.

 (2) non-specific inflammatory changes both in the large and small intestine.


Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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