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Radiologic Diagnosis of Colonic Tuberculosis Hikoo Shirakabe 1 1Department of Gastroenterology, School of Medicine, Juntendo University pp.1597-1622
Published Date 1977/12/25
DOI https://doi.org/10.11477/mf.1403112433
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 Macroscopic and radiologic study of colonic tuberculosis was made, based upon 79 operated cases of inflammatory diseases of the intestine, including 47 cases of tuberculosis, 21 cases of Crohn's disease, 9 cases of ulcerative colitis and 2 indeterminate cases.

 As the first step of this study, color, and black and white pictures of the operated materials were arranged at random, and the macroscopic diagnosis was made on each case, regardless of the diagnosis before surgery. Thirty-four cases were macroscopically diagnosed as tuberculosis, including 5 cases localized in the small intestine. Of these, the final diagnosis of Crohn's disease were made on 1 case of tuberculosis involving the ileum and the right colon and 1 case of the ileum. Accuracy of the macroscopic diagnosis was 94%. On the other hand, there was 1 case of tuberculosis in the final diagnosis which was macroscopically diagnosed as Crohn's disease. In addition, there were 14 indeterminate cases on the macroscopic diagnosis which revealed “scarred area with discoloration” in the entire lesion. Of these, 3 cases were histologically diagnosed as tuberculosis because they revealed caseation necrosis either in the lesion or the lymph node. Eleven of them which histologically revealed only atrophic mucosa and fibrosis of the submucosal layer were also macroscopically diagnosed as tuberculosis because “the scarred area with discoloration” was not observed in the other inflammatory bowel diseases. The scarred area with discoloration is one of the components which constitute a tuberculous lesion in most cases.

 Generally, the radiologic diagnosis of colonic tuberculosis can be established if a combination of transverse ulcer, the scarred area with discoloration and characteristic deformity of the viscus are visualized in double contrast radiography. A transverse ulcer is usually linear or girdle-like in form and annular. The radiologic findings of the scarred area with discoloration consists of a slightly rough mucosal surface delineated as abnormal barium coating where mucosal convergence and inflammatory polyps are scattered. The deformity includes shortening and narrowing of the viscus, disappearance of the haustration, stenosis, depressed sign and pouch-formation (pseudo-diverticulum).

 Various degrees of stenosis and bilateral depression are visualized at the site of the transverse ulcer. Disappearance of the haustration is associated with the scarred area with discoloration. Pouch-formation is often visualized in the cecum.


Copyright © 1977, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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