回盲部結核の1例

Intestinal Tuberculosis in the Ileocecal Region, Report of a Case

要旨　患者は46歳，男性．主訴は右下腹部痛である．理学的，臨床検査成績では異常所見を認めない．X線所見上は狭細化した回腸末端部に粗糙な粘膜と縦走潰瘍が認められた．内視鏡所見では回盲弁上に浅い，不整形の潰瘍がみられ，回腸末端部には縦走潰瘍がみられた．しかし，cobblestone像は認められなかった．この部より採られた生検標本には多数の非乾酪性肉芽腫があった．これらの所見は腸結核でもCrohn病でもみられる所見であり，術前に正しい診断を付けることはできなかった．切除標本では樹枝状の線状潰瘍のある長さ10cmの瘢痕帯と回盲弁上の浅い輪状潰瘍が認められた．病理組織学的には多数の非乾酪性肉芽腫が腸壁の各層にみられた．病理所見上は腸結核の診断が付いた．

　A 46 year-old man was admitted to the hospital complaining of right lower abdominal pain. Physical and laboratory examinations revealed no significant abnormalities.

　Radiological study demonstrated narrowing of the terminal ileum with coarsened mucosa and longitudinal ulcers.

　Endoscopical examination disclosed shallow, inrregularly-shaped ulcers on the ileocecal valve and longitudinal ulcers in the terminal ileum. The so-called “cobblestone appearance” was not seen around the ulcers. Biopsies taken from these areas proved to be the noncaseating granulomas.

　Since these findings can be either due to ileocecal tuberculosis or Crohn's disease, we could not make definite diagnosis before surgery.

　Resected specimen showed about 10 cm long, girdle scarred area with branching linear ulcers in the terminal ileum, and a shallow circular ulceration on the ileocecal valve.

　Histologically, many non-caseating granulomas were found in each layer of the intestinal wall and in regional lymph nodes, establishing the diagnosis of tuberculosis.

　Longitudinal ulcer, usually seen in Crohn's disease, did not help us in making correct diagnosis in this case. This type of linear ulcer is also seen in the girdle ulcer as a cracked surface.

　In order to make an accurate diagnosis of this type of intestinal tuberculosis, one should always bear in mind the possible presence of such a characteristic macroscopic features seen in the intestinal tuberculosis.