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A Case of Probable Intestinal Tuberculosis H. Kishikawa 1 , K. Ohsato 1,2 , T. Yao 3 , K. Watanabe 4 1The 1 st Dept. of Surgery, Faculty of Medicine, Kyushu University 3The 2 nd Dept. of Internal Medicine, Faculty of Medicine, Kyushu University 4The 2 nd Dept. of Pathology, Faculty of Medicine, Kyushu University pp.1249-1254
Published Date 1978/9/25
DOI https://doi.org/10.11477/mf.1403107513
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 A 56-year-old man was admitted to our clinic with a long history of recurrent abdominal pain, anemia, gurgling sounds and constipation.

 He had a history of left nephrectomy for renal tuberculosis in 1960.

 His first abdominal symptoms occurred in 1961, when he was admitted to a local hospital due to tarry stool, gurgling sounds, constipation and general fatigue. On explorative laparotomy he was diagnosed as having intestinal tuberculosis and was on antituberculous treatment for six months with good result. Since then he was free from symtoms until 1964, when he was admitted to our clinic due to the same complaints. On exploration there were five encircling strictures at the distal ileum 50 cm away from the ileum end. He was treated again by the antituberculosis drugs for three months. After that time he improved in health except occasional slight abdominal pain. In 1974 he was readmitted to our clinic due to frequent abdominal pain and general fatigue. On admission he had anemia and hypoproteinemia. Roentgenographic examination showed multiple strictures of the small intestine. His Mantoux reaction was positive but continuous fecal culture for tubercle bacillus was always negative. Occult blood of stool was always positive. Chest X-ray films revealed no abnormal shadow. As his symptoms were not improved by antituberculous treatment, operation (multiple resections with end-to-end anastomoses) was carried out. The resected specimens showed multiple linear ulcers from the distal jejunum to the proximal ileum, and two pseudoenteloliths coexisted with these ulcers.

 The histological specimens showed chronic non-specific ulcers (Ul-Ⅱ~Ⅳ), two ulcers being open, and two atrophic non-caseating granulomas in the submucosa of one of 71 sections. Mesenteric lymph nodes revealed only chronic non-specific lymph-adenitis.

 Postoperative course was uneventful and he has been doing well since discharge.

 In this case tubercle bacilli or microscopic tuberculous lesions were not recognized but clinical course and macroscopic appearance strongly suggest tuberculosis of the 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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