腸結核を強く思わせた1症例

A Report of Colonic Lesions Recently Encountered that Closely Resembled Intestinal Tuberculosis

　抗結核剤の登場以来，わが国でも，欧米諸国に次いで腸結核症は減少し，これに遭遇する機会は少ない．しかし診断過程において，その症例に直接結核菌や乾酪性肉芽の証明が得られない場合，鑑別診断上，特にCrohn病との比較で問題となることが多い．最近われわれはちょうどこのような症例を経験したので例証する．

　Case: a 57-year-old female, company employee.

　Chief complaint: bloody stool. Family and past histories were not contributory.

　X-ray examination of the colon with barium enema revealed that the colon from the ileocecal region up to the ascending colon was highly deformed and shortened with narrowing of the lumen. Changes suggesting diverticula were also seen along the margins. No haustra could be seen. Faint mucosal convergencies were seen in the ascending and transverse colon. As the patient died suddenly of pulmonary artery thrombosis, she was autopsied. There was no fistula in the abdominal cavity. Adipose tissue in the retroperitoneal cavity and mesentery was thickened. The ascending colon was shortened to 15 cm. Its lumen was narrowed with changes suggesting many diverticula. Small ulcers were seen in the right half of the colon in several places.

　Histologic examination showed that in the segment from the ileocecal part of the ascending colon was seen hypertrophic fibrosis of the submucosa affecting also the muscular layer. The muscularis mucosae was also hypertrophied. Inflammatory cellular infiltration was slight. No hyaline tubercle was observed. The mucosa around ulcers in the transverse colon showed epithelial regeneration. At the base of the ulcer were seen tuberculoid granulomas corresponding in site to lymph follicles. The tubercles consisted of giant cells, small and thin epithelioid cells and surrounding lymphocytes. No obvious caseous necrosis was seen. Staining for acid-fast bacilli was negative.

　Pathologically, (1) no tuberculous bacilli were demonstrated; (2) there was no caseation necrosis; (3) no granulomatous adhesion was recognized; and (4) no tuberculous lesions were seen in the regional lymph nodes.