腹壁膿瘍ならびに瘻孔形成を認めた横行結腸結核の1例

Tuberculosis of the Transverse Colon Associated with Fistula and Abdominal Abscess, Report of a Case

　本邦において腸結核は決してまれな疾患ではなく，しばしば経験されている．しかも，昔の活動性病変の多い時代に比べ，最近では治癒傾向が強く，瘢痕化したものが多く，一層病変の形態を多彩なものにしており，クローン病や潰瘍性大腸炎などの炎症性腸疾患との鑑別が重要な課題となってきている．また，腸結核の局所性の合併症として，腸狭窄，腸出血，膿瘍形成，穿孔，瘻孔形成，癒着などが挙げられているが，実際上，膿瘍や瘻孔を形成した腸結核は極めて少なく，鑑別診断に苦慮する．

　今回，われわれは瘻孔を形成し，腹壁に膿瘍を伴った横行結腸結核の1例を経験したので報告する．

　A report is made of tuberculosis of the transverse colon with fistulation accompanied with abscess of the abdominal wall. The patient is a 54-year-old woman hairdresser. Her chief complaints were a mass and tenderness in the lower left part of the abdomen. She had undergone appendectomy in the past. Examinations at admission revealed no particular changes except accelerated blood sedimentation rate, positive CRP and very positive tuberculin test. Barium enema examination showed displaced transverse colon due to a tumor and the segment was constricted very much. The intestinal wall was irregular, showing adhesion of the tumor with the intestinal segment. On the anterior wall revealed by double contrast study were shown an ulcer of irregular shape with mucosal convergence and small granular protrusions in addition to a small ulcer scar accompanied by converging mucosal folds. No abnormal changes were seen in other parts. Endoscopy showed an ulcer of irregular shape accompanied with white coat. The surrounding mucosa was edematous and turbid, showing a gentle upraising suggesting a submucosal tumor. However, biopsy done at the same time strongly suggested a tuberculous change. Abdominal CT and US puncture suggested an abscess of the abdominal wall. As we arrived at a diagnosis of abscess of the abdominal wall due to perforation of intestinal tuberculosis, laparotomy was performed. Abscess was seen in the abdominal wall and a fistula was formed between the wall and transverse colon. A great mass of the omentum was formed around the fistula, forming a tumor. Partial resection of the transverse colon was done. Histological findings of the resected specimen suggested that the lesion was of tuberculous nature.