小腸に多彩な潰瘍を認めた腸結核の1例

Tuberculosis of Small Intestine: Report of a case

　クローン病の鑑別すべき疾患として，腸結核が再び問題にされるようになった．抗結核剤の開発に伴い，結核の症例は少なくなったとはいえ，本邦においては，腸の潰瘍性病変をきたす疾患のうち腸結核が占める比率はまだ少なくない．われわれは，最近，腸閉塞をきたしたため手術を施行し，病理学的検索を行なうことができた腸結核の1例を経験し，小腸の病変についてX線学的に検討したので報告する．

症例

　患　者：M. M.　56歳　男性

　主　訴：腹部膨満感，下腹部痛

　前病歴・家族歴：特記すべきことなし

　現病歴：1975年10月末より食欲不振，便秘をきたすようになり，その後，腹部膨満感および下腹部痛を伴うようになった．1976年1月5日，某医受診し，経口腸および注腸X線検査を受け，小腸および大腸に異常を指摘されて，1976年2月10日，精査のため当科へ入院した．なお，1975年10月より入院時までに約8kgの体重減少をきたしていた．

　A 56-year-old man was admitted with the complaints of constipation and vague abdomimal pain. Routine barium meal studies showed multiple diseased segments with normal skip areas in between in the small intestine and two extensive irregular ulcers in the ascending colon and cecum. Multiple irregular ulcers with sharp margins were well demonstrated by double contrast study and compression technique of the small intestine. Some showed converging mucosal folds and overhanging shelves. There were two localized annular strictures with sharp margins and loss of mucosal folds. These roentgenological appearances are consistent with intestinal tuberculosis. Mycobacterium tuberculosis was cultured from stool and sputum.

　Tne administration of antituberculous drugs was started on Feb. 18, 1976, and he responded vaell. However, he started to develop intestinal obstructions since May, 1976, and he finally underwent laparotomy on July 28, 1976. There were 24 ulcers in the small intestine resected.

　For the X-ray diagnosis of small intestine, the demonstration of the mucosal details is important. To achieve this, the double contrast study and compression technique are indispensable. The shape of the ulcer with or without convergence of mucosal folds can be well demonstrated with these techniques.