多発性十二指腸小腸結核の1例

A Case of Multiple Tuberculous Ulcerations in the Upper Intestinal Tract

　化学療法の進歩により腸結核は次第に減少する傾向にあるが，今日でもしばしばその症例が報告されている．腸結核の大部分は下部腸管とくに回盲部にみられるのに対し，上部腸管なかでも十二指腸に発生することは稀であるが，我々は最近主に上部腸管すなわち十二指腸，空腸および回腸の一部にわたり多発性の結核性潰瘍を認めた1例を経験したので報告する．

症例

　患　者：三〇マ○　56歳　女

　主　訴：腹痛および便秘．

　家族歴：父が67歳で吐血死．

　既往歴：26歳のとき肺炎に罹患．50歳のとき虫垂切除術をうける．

　現病歴：約3年前から軽い腹痛があったが最近次第に強くなり，全身倦怠感，食欲不振を自覚するようになった．嘔吐はない．便通は1日1行であるが固い便が少しずつ出るのみで排便の満足感がない．胃レ線検査を行なったところ十二指腸下行脚に軽い狭窄を認めたので（図1a，b）更に精査を行なった．

　Cace: a 56 years old female. A case of six tuberculous ulcerations in the relatively upper intestinal tract from the duodenum to a part of the ileum is reported. The patient complained of abdominal pain and constipation. X-ray revealed a girdle-like ulceration in the descending duodenum and similar lesions in several other places in the small intestine.

　Endoscopy revealed an irregular ulceration with edema of the surrounding mucosa in the duodenum. The operation was performd after two months of conservative treatment. On surgical exploration, tumor-like resistency was palpable near the center of the descending duodenum, and there were observed localized thickening of the wall and slight narrowing at each part 25 cm, 40 cm, 100 cm, 300 cm and 380 cm, respectively, anal from the ligament of Treitz in the small intestine. The small intestine was resected at each part of the five lesions. Histological diagnosis was tuberculosis.

　As the lesion in the duodenum was not malignant as revealed by the preoerative biopsy, and was near to the head of the pancreas, and the passage failure was hardly observed, surgical treatment was not attempted. This lesion was also considered a tuberculous ulceration, because it was healed by tuberculostatic drugs and by x-ray it was similar to other lesions in the small intestine which had been confirmed tuberculous histologicaly.

　Though the most common location of intestinal tuberculosis is in the ileocecal area, in this case multiple tuberculous ulcerations were observed in the relatively upper intestinal tract including the duodenum. Such a cace as this is rare in literature and diagnostically interesting.