診断的腹腔鏡検査により迅速な診断が可能であった結核性腹膜炎の2例

Two case reports of peritoneal tuberculosis rapidly diagnosed by laparoscopic examination

◆要旨：診断的腹腔鏡検査により迅速な診断が可能であった結核性腹膜炎の2例を経験した．症例1は47歳，男性．発熱を主訴に受診した．CT検査で大網の肥厚を認めたが，精査で腫瘍性病変は認めなかった．診断的腹腔鏡検査を行い翌日に迅速病理検査，結核菌polymerase chain reaction検査（以下，Tb-PCR）により結核性腹膜炎と診断された．症例2は87歳，女性．発熱を主訴に救急外来を受診した．CT検査で腹水と大網肥厚を認め，精査で悪性疾患を認めなかった．診断的腹腔鏡検査を行い迅速病理検査，Tb-PCRにより結核性腹膜炎と診断された．結核性腹膜炎に対する診断的腹腔鏡は感度，迅速性の面で有用な検査である．

Two patients with peritoneal tuberculosis were rapidly diagnosed by laparoscopic examination. A 47-year-old man presented with a 4-month history of fever. A CT scan showed omental thickness, but no tumorous region was detected by detailed examination. Diagnostic laparoscopy was performed and he was diagnosed as tuberculous peritonitis by intraoperative frozen section and polymerase chain reaction of tuberculosis（Tb-PCR） on the next day. An 87-year-old woman with fever came to our emergency department. A CT scan showed ascites and omental thickness, but no malignant disease was detected by detailed examination. Through diagnostic laparoscopy, she was diagnosed as tuberculous peritonitis by intraoperative frozen section and Tb-PCR on the next day. Diagnostic laparoscopy is useful for the diagnosis of tuberculous peritonitis in the aspect of sensitivity and rapidity.