腹壁結核の1例 A PATIENT WITH ABDOMINAL TUBERCULOSIS

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著者

    • 奥村 権太 OKUMURA Gonta
    • 聖マリアンナ医科大学横浜市西部病院外科 Department of Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
    • 小森山 広幸 KOMORIYAMA Hiroyuki
    • 聖マリアンナ医科大学横浜市西部病院外科 Department of Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
    • 坂本 恒明 SAKAMOTO Tsuneaki
    • 聖マリアンナ医科大学横浜市西部病院外科 Department of Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
    • 高橋 直人 TAKAHASHI Naoto
    • 聖マリアンナ医科大学横浜市西部病院外科 Department of Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
    • 田中 一郎 TANAKA Ichiro
    • 聖マリアンナ医科大学横浜市西部病院外科 Department of Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
    • 萩原 優 HAGIWARA Masaru
    • 聖マリアンナ医科大学横浜市西部病院外科 Department of Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital

抄録

症例は62歳,女性.平成13年3月頃より臍下3横指尾側正中部に4cm大の腫瘤を触知し当科受診.胸部X線写真で左肺野に散在する結節影を認め,腹部CTでは腹直筋内に被膜を伴う腫瘤として描出され,腸間膜リンパ節の石灰化を認めた.消化管造影検査では異常所見を認めなかった.腹壁膿瘍の診断のもと,腫瘍直上にて切開したところ,濃粘調性の白色膿汁が流出した.膿瘍部を掻爬し開放ドレナージとした.腸管との交通を検索すべく小開腹を行ったところ,腹腔内の著明な癒着と腸管漿膜面の白色顆粒状の小結節が多数認められた.膿瘍壁の病理学的所見では炎症性肉芽組織と乾酪,類上皮性肉芽組織を認めた.膿汁のPCR法にて結核の同定がされた.腹壁結核と診断し術後抗結核剤の投与を開始した. 1987年以降,本邦での腹壁結核の報告は10例であり稀な疾患である.若干の参考的文献とともに報告する.

A 62-year-old woman visited our department with a swelling 4cm in diameter that she had begunto feel in the midline of her abdomen, about 3 fingerbreadths below the umbilicus, since March 2001. Chest radiography revealed disseminated miliary shadows in the left lung. Abdominal computed tomography (CT) disclosed an encapsulated mass in the rectus abdominis muscle and calcification of the mesenteric lymph nodes. Gastrointestinal contrast-radiographic findings were normal. With the diagnosis of abdominal abscess made based on the above findings, a skin incision was made immediately over the swelling. Thick viscous white pus squirted out. An incision was then made over the abscess, and open drainage was performed. A small exploratory laparotomy performed for examining intestinal communication revealed significant intraabdominal adhesions and numerous white granular tubercles on the serosal surface of the intestine. Histopathology showed inflammatory granulation tissue with caseous necrosis, and epithelioid granulation tissue on the wall of the abscess. The presence of Mycobacterium tuberculosis in the pus was confirmed by the polymerase chain reaction (PCR) method. A diagnosis of abdominal tuberculosis was thus made. Antituberculous chemotherapy was initiated postoperatively. Besides this patient, only 10 patients with confirmed abdominal tuberculosis have been reported in Japan since 1987. We present here our patient with abdominal tuberculosis, with a review of some relevant literature.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 63(5), 1288-1291, 2002-05-25

    Japan Surgical Association

参考文献:  15件中 1-15件 を表示

被引用文献:  1件中 1-1件 を表示

  • 腹壁結核の1例

    鈴木 幸正 , 中川 国利 , 遠藤 公人

    日本外科系連合学会誌 32(5), 825-828, 2007-10-30

    医中誌Web 参考文献7件 被引用文献1件

キーワード

各種コード

  • NII論文ID(NAID)
    10008913424
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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