腸結核疑診の1例

A Case of Right-Sided Colitis Suggesting Intestinal Tuberculosis

　近年，抗結核療法の進歩による肺結核の減少とともに，本邦においても腸結核は減少しているものの，いまだ日常臨床上，稀な疾患であるとはいい難い¹⁾．同時に化学療法の普及によって，腸結核の病像は多少とも変化している可能性もあり，臨床的にも病理学的にも腸結核が典型的な病像をあらわさず，非特異性炎症としての所見を示すにとどまる場合も少なくない．このような場合，潰瘍性大腸炎やCrohn病との鑑別が問題になるであろうが，最近，われわれも炎症が瘢痕治癒してしまい，臨床的にも病理学的にも非典型的な病像しかあらわさなかった腸結核と思われる症例を経験したので報告する．

症　例

　患　者：59歳　女性　調理師

　主　訴：右下腹部の不快感

　家族歴・既往歴：特記事項なし

　現病歴：過去に激しい下痢や下血，腹痛などを訴えたことはなかったが，数年前から時々右下腹部に不快感を訴えることがあった．この間，腹痛，発熱，体重減少や便通異常もなかったため放置していたが，最近，知人に大腸癌が発見されたため，自らも大腸癌を懸念して精査を希望して来院した．食欲は良好で，便通は2日に1行程度の割合で正常便をみる．

　Since the advent of antituberculosis drugs, intestinal tuberculosis is decreasing in its frequency. However, it is not so rare and is more frequent than Crohn's disease among the Japanese. Diagnosis of intestinal tuberculosis is not so difficult if tubercle bacillus or granuloma with caseation necrosis is found out in the biopsy specimen, resected tissue or fecal materials. However, intestinal tuberculosis is generally curative with or without antituberculosis drugs, and shows only non-specific inflammatory changes histologically. It is not so easy to differentiate healed tuberculosis from other inflammatory bowel diseases.

　A 59 years old woman was admitted to our hospital, complaining of abdominal discomfort in the right lower quadrant for several years. Barium enema study revealed shortening and deformity of the right colon and terminal ileum. Irregular network pattern with several mucosal convergencies was seen at the lesion, but the rectum, sigmoid and descending colon were not involved. These findings were very suggestive of healed intestinal tuberculosis. Histological findings of the mesocolic lymph node revealed giant cells with hyalinsation, but no typical granuloma with caseation necrosis was seen. Although histological finding was not typical of intestinal tuberculosis, its radiological findings and clinical course suggested the healed stage of intestinal tuberculosis.

　For the X-ray diagnosis of the healed stage of intestinal tuberculosis, it is necessary to collect more examples of completely healed or non-typical cases of this disease. Our case would be valuable as additional radiologic findings of healed intestinal tuberculosis.