全割による再構築からみた小腸結核のX線像―瘢痕を中心として

Roentgenographic Study of the Tuberculosis of the Small Intestine Based on Wholly Sectioned Specimens

　腸の検査法が進歩し，潰瘍性病変の発見も容易になってきて，従来わが国に少ないとされていた潰瘍性大腸炎，クローン病に対する関心も高まってきた．当然ここでわが国に多い腸結核がこれらの炎症性疾患との鑑別の対象として，大きくクローズアップされてきている．腸結核のX線診断に関する外国文献は数多いが，今日これらに基づいてX線診断に臨んでみても確診に至らない症例が少なくない．

　それは従来の診断学が総括的な所見だけで，肉眼所見の裏づけに乏しいこと，もう1つは腸結核自体が化学療法によってその様相が変わってきており，今日われわれが対象とするものには，黒丸の分類にみられるopen ulcerが少なく，瘢痕が大部分を占めるようになったためであろう．

　The X-ray findings of tuberculosis of the small intestine were studied by comparing with histological features of the lesion (mainly scar) which corresponded to those findings. In each case the whole specimen was sectioned for detailed histological examination. Three cases with different types of ulcer scar were chosen as the subjects of the study out of 5 cases with small bowel involvement which had histologically proved granuloma with caseation necrosis in the intestinal wall or in the regional lymph nodes. (The results were as follows.) For the purpose of studying X-ray findings ulcer scars were classified into 4 types (girdle ulcer scar, partial girdle ulcer scar, extensively scarred area and small ulcer scar less than 5 mm in diameter) according to their extension and distribution.

　1. Girdle ulcer scar was associated with decreased distensibility of the contour on both sides. Besides concentric stricture, eccentric one which is usually seen in Crohn's disease, was detected. The contour was smooth and Kerkring folds were absent. Various sizes of barium flecks, fine granular shadows, transverse barium shadows were seen.

　2. Partial girdle ulcer scar was sometimes recognized accompanied with unilaterally decreased distensibility of the contour. The contours were not always smooth and in some cases Kerkring folds remained, presenting various changes.

　3. Bilaterally decreased distensibility of the contour was usually recognized in extensively scarred area. But mucosal changes or decreased distensibility of the contour was not always uniform showing asymmetric contour changes. Therefore, complex findings were sometimes seen including longitudinal changes which usually are characteristic of Crohn's disease and findings seen in multiple gastric ulcer or early gastric cancer of type Ⅱc etc., as well as transverse changes commonly seen in intestinal tuberculosis. The contour was smooth in the greater part of cases.

　4. Specific X-ray feature of dilatation of the bowel lumen associated with anular stricture in the anal and/or oral side was seen.

　5. Extension or existence of scarred area could not always be shown macroscopically.

　6. Some macroscopically undetectable ulcer scar were shown roentgenographically in tumors of decreased distensibility of the contour.