多発性輪状狭窄を呈した腸結核疑診の1例

A Case of Probable Intestinal Tuberculosis

　最近の診断学の進歩によりクローン病をはじめとする腸の潰瘍性病変が注目されてきた．このうちでも腸結核は本邦においては決して稀な疾患ではなく，抗結核療法の進歩，普及に伴い，そのX線像や病理学的所見も複雑となり，その診断に苦慮することが少なくない．

　われわれは，長期間にわたり腸閉塞様症状を訴え，X線像で多発性の小腸輪状狭窄を認め，切除しえた空腸の病理学的所見では，いわゆる“非特異性炎症”の像を呈し，腸結核の診断に必要とされている「抗酸菌ないし結核菌」，「乾酪性肉芽腫」のいずれをも証明できなかったが，諸種の成績より腸結核と考えられる症例を経験したので報告する．

症　例

　患　者：井○フ○子　61歳　♀　主婦

　主　訴：腹痛

　既往歴：虫垂切除術（47歳），右乳癌根治術（49歳），胆囊摘出術（54歳）

　家族歴：特記すべきことなし

　現病歴：1967年，胆嚢摘出術を受けた．その後，年に1～2回ほど腹痛（下腹部より心窩部にかけての突き上げるような痛み），腹部膨満感，悪心，嘔吐を認めるも，数日間にて症状軽快するので放置していた．1974年5月，再び上記症状出現し，今回は頑固に持続するために某医を受診し，消化管X線検査を受け，小腸の一部に狭窄を疑われ，1974年7月，検査目的にて福岡赤十字病院に入院した．

　A 61-year-old woman was admitted to our hospital with a long history of abdominal pain. She had no history of active tuberculosis of the lung or any other organs. Her Mantoux reaction was positive but continuous fecal culture for tuberculous bacillus was always negative. Barium meal studies showed multiple annular stenoses associated with scattering dilatation in the small intestine, cecal deformity and narrowing of the splenic flexure. After administration of antituberculous drugs she developed a more serious intestinal obstruction and underwent emergency laparotomy. The most stenotic portion presenting at the most proximal site was resected.

　The resected jejunum showed a circular ulcer with convergence of the mucosal folds and scarred areas proximal to the ulcer. Histologic study showed a non-specific healed circular ulcer, Ul-Ⅱ, with regenerating epithelium, pyloric gland metaplasia and submucosal fibrosis or fibromusculosis. There were no histologic evidences of tuberculosis, such as caseating or non-caseating tubercles, or acid-fast bacilli in the both the jejunum and the lymph nodes. In addition, the dilated jejunum proximal to the circular ulcer had multiple scars histologically the same as the previous ulcer. Putting together all of the clinical history, laboratory examination, X-ray findings and pathological appearance, this case is suspected as a healed intestinal tuberculosis.