肺結核の治療中に小腸穿孔をきたした腸結核の１例

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  • A CASE OF INTESTINAL TUBERCULOSIS WITH JEJUNAL PERFORATION

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We experienced a case of peritonitis due to jejunal perforation caused by intestinal tuberculosis.<br> A 55-year-old man complaining of pharyngeal discomfort and poor appetite was admitted to the hospital with a diagnosis of pulmonary tuberculosis. Antituberculous regimen with 4 types of drugs (INH, REF, EB and PZA) was started, but he had the sudden onset of abdominal pain 16 days after admission. A chest X-ray examination revealed free air below the diaphragm. Gastrointestinal perforation was diagnosed and an emergency operation was performed. A perforation 10mm in diameter was located about 50cm proximal to the ileocecal valve, and 6 ulcers completely encircling the bowel were present in the vicinity of the perforation. A diagnosis of generalized peritonitis due to jejunal perforation was made, and the resection of the perforated intestine, including 4 out of the 6 ulcers, was performed. The other 2 ulcers were not resected because there were far from the perforation. Antituberculous therapy was resumed. The postoperative course was uneventful and the patient was discharged from the hospital 5 months after the operation. Intestinal tuberculosis is primarily treated with antituberculous drug regimen, however, emergency surgical resection must be indicated if intestinal perforation occurs. In performing the resection, the volume of the bowels to be removed should be decided carefully, considering both residual stenosis and the function of the remnant intestine.

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