結核による十二指腸狭窄の1例

A CASE OF DUODENAL STRICTURE DUE TO TUBERCULOSIS

Ⅰ．症例

　患者：加○清○　34歳　男子　会社員

　初診：昭和42年2月13日

　手術：昭和42年2月25日

　主訴：心窩部痛，嘔吐

　既往歴：13歳の時，左肺結核に罹患し7力刀間の入院加療を受けた．また20歳頃に数カ月にわたり食欲不振が続き，某医を訪ずれ，慢性胃炎の診断にて外来治療を受けた．それ以後は著患を知らず正常の生活をしてきた．

　現病歴：昭和41年夏頃から心窩部に重苦しい感じがあり，食欲が減退してきた．重苦しい感じは一進一退あって，時に過食の後では嘔吐することがあった．昭和42年2月10日突然原因不明の下痢があり，それは間もなくおさまったが，以来嘔気，呑酸，便秘などの症状が強く現われてきた．2月12日から嘔吐が頻回になり，心窩部痛もかなり強いものになってきたので入院した．

　A 34-year-old male, who had previous history of lung tuberculosis, was admitted to the authors' hospital, because of severe, recurrent vomiting of ten days' duration. He had had since half a year ago epigastric distress, nausea, and loss of appetite.

　X-ray study of the patient disclosed a high-grade stricture in the pars descendens of the duodenum. The constricted region looked like a gourd, with slight marginal rigidity.

　The location of the stricture suggested the existence of anuular pancreas, but marginal rigidity was taken into account, and under tentative diagnosis of intestinal stricture due to tuberculous scar formation, the patient underwent operation. At that time, he was in such a poor state that, instead of intestinal resection, a longitudinal section was done in the constricted part. After making sure that the thumb of the operating surgeon easily passes through the constriction, the incised part was transversely sutured for two layers. The existence of intestinal tuberculosis was confirmed by histopathological study of specimens taken from the incised region. After the operation chemotherapy is being continued. The patient is making favorable progress toward recovery.

　This case is described here in detail, because it is believed to be a rare case in gastsrointes tinalroentogenology.