自然治癒したと考えられる腸結核の1例

Probable Tuberculosis of the Right Side of the Colon, Report of a Case

　最近，わが国においては全結核の減少と共に結核の罹患年齢も高齢化の傾向にある¹⁾．腸結核についても同一傾向にあると思われ，その病像も陳旧化したものや非典型的なものがみられ，Crohn病や潰瘍性大腸炎などとの鑑別診断が，臨床的にも病理学的にも困難な例が多くなってきた．われわれは，臨床的には大腸結核と診断しえたが，病理組織学的には結核結節が全くみられず，その他の組織所見および肉眼像より治癒した腸結核と診断した例を経験したので報告する．

　症　例

　患　者：72歳，女性．

　主　訴：腹部膨満感．体重減少．

　家族歴：弟，肺結核．

　既往歴：42歳時，肺結核症で加療．

　現病歴：1978年ごろから体重減少が始まり2年間で13kgの減少をみる．1980年5月ごろより腹満感があり，近医受診し市販薬により軽快したが，1981年2月再び心窩部不快感，食欲不振，腹部膨満感が出現した．再び近医受診し胃X線検査を受け異常なしと言われたが，症状が持続するため当院を受診し，精査・治療の目的で入院となる．

　A 72 year-old woman was admitted to our hospital, complaining of abdominal fullness and weightloss for two years. At the age of 42 she was treated for pulmonary tuberculosis. Laboratory studies revealed positive PPDS and slight anemia. Barium enema study showed shortening and deformity of the right colon and terminal ileum. Disappearance of fine network pattern with slight mucosal convergencies and multiple polyps were seen at the lesion. The other parts of the colon and small intestine were not involved. Laparotomy was done and right hemicolectomy was performed. Macroscopic study of the resected specimen revealed several mucosal convergencies and multiple polyps which lay irregularly scattered al the lesion. These findings were very suggestive of healed tuberculous colitis. Histological findings revealed only multiple ulcer scars with submucosal fibrosis and inflammatory polyps. Acid fast bacilli and tuberculous granuloma could nod be found. Putting together all of the clinical history, laboratory examination, x-ray examination and pathological findings, this case is suspected as a healed tuberculous colitis.