8）消化管結核

Intestinal Tuberculosis

要旨　消化管結核について腸結核を中心に述べた．結核の病原性はKatGとrpoVが大きく関与している．腸結核はX線検査が有効である．X線所見として帯状潰瘍または輪状潰瘍，潰瘍瘢痕を伴う萎縮帯，変形（憩室様変形，狭小化），配列が不規則な小さな炎症性ポリープなどを指摘することにより腸結核の診断ができる．内視鏡所見ではびらん，輪状潰瘍，潰瘍緩痕萎縮帯がみられる．結核菌の証明は潰瘍部の生検を組織培養する．治療は三者併用療法を行う．腸結核に合併した大腸癌をみると，占居部位では右側結腸に，肉眼型ではびまん浸潤型が多い．癌部のX線所見では腸壁の狭小化とバリウムの付着が不良であった．

　Intestinal tuberculosis is mostly tuberculosis in the digestive tract. Radiological examination by double contrast method is effective for the diagnosis of intestinal tuberculosis. In this radiograph, we were able to diagnose the lesion as tuberculosis from the girdle or circular ulcer, the atrophic area with ulcer scars, the deformity of the intestinal wall (pseudo-diverticular deformity, narrowing), and the small irregular inflammatory polyps. In colonoscopic findings, we found irregular erosion, a circular ulcer, an atophic mucosal area with ulcer scars. The infection of Mycobacteria tuberculosis is clearly proved by a culture of the colonic biopsy. Intestinal tuberculosis is treated by using isoniazid, rifampicin and ethambutol. Colorectal cancers imvoloing intestinal tuberculosis were mostly on the right-side colon and their macroscopic form was diffuse invasion type. In radiography of this type of cancer, we recognized decreased distensibility of the colonic wall and poor barium coating of the mucosa.