結核性リンパ節が十二指腸に穿破し, 潰瘍を形成したと思われる十二指腸結核の1例 A case of tuberculous lymphadenitis found as an abdominal mass penetrating the duodenum

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42歳女性.主訴は心窩部痛.画像検査にて右腎内側に4cm大の腫瘤を認め,上部消化管内視鏡で十二指腸下行脚に黄白色調の白苔を有する深い潰瘍性病変を認めた.超音波内視鏡で潰瘍と腫瘤に連続性が認められた.潰瘍底の生検組織を用いた結核菌遺伝子PCR検査で陽性所見が得られた.結核性リンパ節が十二指腸に穿破した十二指腸結核と診断し,抗結核療法による内科的治療で治癒した1例を経験したので報告する.<br>

A 42-year-old woman who complained of epigastralgia was referred to our hospital because of an abdominal mass found by ultrasonography. CT and MRI scans revealed that the abdominal mass, 4 cm in diameter, located on the left side of the right kidney. Gastroduodenoscopy detected a deep ulcerative lesion covered with a yellowish coat in the second portion of duodenum. A sonolucent area at the bottom of the ulcerative lesion seemed to expend to the abdominal mass on ultrasonic endoscopy. Tuberculosis was one possible differential diagnosis. Pathological examination including Ziehl-Neelsen staining using biopsy specimens taken from the bottom of the ulcerative lesion did not show tuberculosis infection. However, polymerase chain reaction analysis using the biopsy specimens revealed that gene expression of tuberculosis was positive. We determined that tuberculous lymphadenitis penetrated the duodenum forming an ulcerative lesion in the duodenum. The administration of anti-tubercular medicine for 6 months male the abdominal mass disappeare and the duodenal ulcerative lesion formed an ulcer scar. We report here a case of tuberculous lymphadenitis penetrating the duodenum which was successfully treated by conservative therapy without surgical treatment.<br>

収録刊行物

  • 日本消化器病學會雜誌 = The Japanese journal of gastro-enterology  

    日本消化器病學會雜誌 = The Japanese journal of gastro-enterology 103(8), 948-954, 2006-08-05 

    The Japanese Society of Gastroenterology

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各種コード

  • NII論文ID(NAID)
    10018364379
  • NII書誌ID(NCID)
    AN00192124
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    04466586
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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