Diagnosis of Ileocecal Tuberculosis: A clinico-pathological study on 12 operated cases M. Maruyama 1 1Dept. of Internal Medicine, Cancer Institute Hospital pp.865-881
Published Date 1974/7/25
DOI https://doi.org/10.11477/mf.1403111947
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 Radiological, endoscopical, bacteriological and histopathological study was done on 12 cases of ileocecal tuberculosis which had been operated upon in the period of 17 years from 1956 to 1973, and the following result was obtained.

 1, Radiologically, the diagnosis of tuberculosis was made in 8 of 12 cases. In the remaining 4 cases, 1 case was diagnosed as ulcerative colitis; 1 cases as cecal carcinoma associated with ulcerative colitis ; 1 case as carcinoma of the ascending colon and 1 case as Crohn's disease. In the radiological diagnosis, it is most important to visualize not only deformity and shortening of the bowel as a whole but also details of lesion such as linear ulcer, ulcer scar and pseudopolyps by the double contrast radiography. The diagnosis of the ileocecal tuberculosis is made possible by radiological reproduction of macroscopic pathology.

 2. Fibercolonoscopy was performed in 3 cases and they were dianosed as tuberculosis by the characteristic finding of linear ulcer and pseudopolyps. Biopsy was done in 3 cases and a granuloma with a giant cell was found in only one case. In the endoscopical diagnosis careful observation of lesions is required in order to establish the correct diagnosis of tuberculosis. For effective biopsy it is necessary to obtain fragments from the deeper portion of ulcer-margin and ulcer-floor.

 3. Bacteriological examination by stool culture and smear test was performed in 5 cases. Of these, tube-rcle bacillus was identified in only one case by continuous stool culture for 19 days, and smear test was positive for tubercle bacillus in 2 cases. These examinations should be performed in every suspected case, although it is relatively difficult to obtain positive result by them.

 4. Fluorescence method for demostration of tubercle bacillus in the operated material was positive in 9 of 12 cases. However, its result was regarded to be unreliable and excluded from the discussion, because 2 cases were positive for tubercle bacillus in the control study of other 12 cases which had been finally diagnosed as non-tuberculous benign ulcerative disease of the ileocecal region.

 5. In the histological study, characteristic tuberculous granuloma with caseation necrosis was observed in 2 of 12 lesions and in 4 cases of the lymph nodes of all cases. The non-caseous granulomatous lesions which were the main histological finding in most cases could be diagnosed as tuberculosis by the fact that they were similar to non-caseous granulomatous lesions coexisting with characteristic tuberculous granulomas with caseation necrosis.

Copyright © 1974, Igaku-Shoin Ltd. All rights reserved.


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