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Stomach and Intestine(Tokyo) Volume 14, Issue 4 （April 1979）

胃と腸 14巻4号（1979年4月発行）

Japanese English

今月の主題症例・研究特集

症例

大量吐下血をきたした十二指腸結核の1治験例 Tuberculosis of the Duodenum with Severe Hematemesis and Melena as Chief Complaint 木林速雄 ¹ , 岡島邦雄 ¹ , 栗原昌樹 ¹ , 木本克彦 ² , 大森浩之 ² , 松浦秀光 ² H. Kibayashi ¹ , K. Okajima ¹ , M. Kurihara ¹ , K. Kimoto ² , H. Ohmori ² , H. Matsuura ² ¹岡山大学医学部第1外科 ²重井病院内科 ¹The First Dept. of Surgery, Okayama University Medical School ²Dept. of Internal Medicine, Shigei Hospital pp.523-528

発行日 1979年4月25日 Published Date 1979/4/25

DOI https://doi.org/10.11477/mf.1403107662

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Abstract 文献概要
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　化学療法の進歩した今日では，腸の結核性病変に遭遇する機会も少なくなってきた．なかでも十二指腸に限局した結核性病変はきわめて稀であり，その診断も困難な場合が少なくない．十二指腸の結核は狭窄症状を呈する場合がほとんどであるが，われわれは最近，大量吐下血をきたした十二指腸第Ⅲ部の結核性潰瘍を経験し治癒できたので若干の考察を加え報告する．

　A 20-year-old man was admitted complaining of pain in the right upper quadrant, general fatigue, persistent and severe hematemesis with melena. Remarkable anemia, hypoproteinemia, hypocholesterolemia, leucocytosis and positive CRP were recognized. 7,000 ml blood transfusion was performed. Chest X-ray picture is noncontributory. Emergent duodenofiberscope showed irregular and bloody ulcer with a small hole in its middle area in the third part of the duodenum, but it was impossible to classify it as malignancy by the biopsy at that time. Similarly, hypotonic duodenography disclosed an irregular ulcer with a protruded picture from its floor like a diverticulum, and mucosal convergence was also seen.

　Four months after admission, abdominal exploration was performed under a suspicion of malignancy. At laparotomy, remarkable tumor with the enlarged lymph nodes was disclosed between the genu inferior and the third part of the duodenum. The enlarged glands developed from the hepatoduodenal ligament to the ileocecal region. As malignant lymphoma was suspected, gland biopsy was performed and gastrojejunostomy was carried out. Histopathology of the glands revealed tuberculous lesion with giant-cell formation and caseation. The patient was diagnosed as having tuberculosis of the duodenum and consequently put on anti-tuberculous treatment.

　Postoperative course was uneventful. The patient responded quite satisfactorily to anti-tuberculous treatment. Endoscopically, the healing of the ulcer was observed. Four months after the first operation, gastrojejunostomy was resected and end to end anastomosis of the jejunum was carried out. Remarkable decrease in size of the glands was observed during this period. Several reports dealing with similar cases were reviewed.