大腸疾患の内視鏡像―（1）腸結核症

Fibercolonoscopic Diagnosis of Intestinal Tuberculosis

　結核の化学療法の進歩ならびに結核予防対策の推進によって，かつて頻々とみることができた腸結核症は，最近非常に少ない疾患となってしまった．今日，一般病院で，日常診療において本症を経験することは稀である．

　過去2年間に，著者らが内視鏡で観察しえた本症は，確診のついたもの4例，強く腸結核症を疑うも，組織学的な裏付けが得られなかったもの3例の計7例であって，いずれの例でも主病変は回盲部に存在した．

　Since the introduction of antituberculotic drugs, it has become seldom to meet a patient with intestinal tuberculosis. They have been especially effective to mucosal tuberculosis such as that of the intestine.

　Even if tubercle bacilli pass into the tubular glands of the intestinal mucosa, early therapy with antituberculotic drugs cleanly wipes out intestinal involvement. Formerly, diagnosis of intestinal tuberculosis was chiefly dependent upon radiologic study. Endoscopic diagnosis even by rigid proctosigmoidscope was impossible except for a rare instance involving the rectum. As in recent years fibercolonoscope (FCS) was brought to actual use, it is now easy to insert the scope even into the terminal ileum retrogradely.

　The ileocecal area is a place where various diseases frequently take place and yet their differential diagnosis is rather difficult. The usefulness of the FCS is especially exhibited here. In this report we have shown endoscopic features of intestinal tuberculosis (acute florid, and chronic cicatrizing cases). It is now very rare to find an acute florid case. In the chronic cicatrizing stage of intestinal tuberculosis it is very difficult to obtain precise diagnosis owing to the difficulty in finding histologic characteristics such as tubercle. We have emphasized that it is still important to keep in mind the existence of tuberculosis in the differential diagnosis of ileocecal disorders.