十二指腸結核の1例

A Case of Tuberculosis of the Duodenum

Ⅰ．症例

患者：○村○ク　52歳　家婦

家族歴：特記すべきことなし．

既往歴：36歳時，虫垂切除．38歳時，腸癒着障害のため剥離術を受けた．

主訴：上腹部の膨満感

現病歴：昭和40年春頃から誘因なく食後．上腹部に膨満感があり，次第に食欲が減退してきた．膨満感は一進一退であったが，著しくなると必ず右側の背部に張ったような疼痛を伴い，苦しさの余り自ら嘔吐すると，吐物に少量であるが3日前の食物が混っていて，嘔吐後急速に諸症状は軽快した．また嘈囃，曖気，悪心，上腹部のモタレ感が常時あったが，絶食を2日位続けるとこれらの愁訴は全く消失した．便通1日1行．体重減少はなかった．昭和43年11月14日初診．

　A 52-year-old female, who had previous history of appendectomy and peritoneal adhesion, was admitted to the author's hospital because of severe recurrent epigastric distress. Since the spring of 1965 she would have epigastric distress, nausea, and loss of appetite.

　X-ray study of the patient disclosed a stricture (about 3cm long) between the genu inferior and pars horizontalis of the duodenum and a diverticulum in the pars infrapapillaris.

　At the site of stricture were observed deficiency of normal Kerckring's folds, mucosal convergence and marginal rigidity.

　By these findings as demonstrated by x-ray examination, operation was performed under a diagnosis of duodenal stricture due to postbulbar ulcer. Method of operation was diverticulotomy and duodenectomy.

　Findings of the resected duodenum: At the part of stricture were observed annular ulceration and underminig ulcer margin.

　Histopathologically, in the muscle layer and marginal zone of the ulcer were found many tubercles and notable cell infiltration (a number of epitheloid cells and a few Langhans's giant cells).

By these findings this ease was diagnosed as of duodenal tuberculosis.

　This case has been here presented with some reference to the literature, because it is believed to be a rare case in gastrointestinal roentogenology.