空腸起始部の狭窄をきたした腸結核の１例

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  • A CASE OF INTESTINAL TUBERCULOSIS CAUSING STENOSIS AT THE ORIGIN OF THE JEJUNUM

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We report a case of intestinal tuberculosis causing stenosis at the origin of the jejunum.<br>A 72-year-old woman diagnosed as having vomiting, dehydration, and pancreatitis due to jejunal stenosis at another hospital was referred to the hospital for close exploration after symptomatic remission with administration of urinastatin and IVH control. After admission to the hospital, hypotonic duodenography visualized remarkable diltation of the descending part of the duodenum, irregular image of the mucosa covering from the horizontal part to the Treitz' ligament, and stenosis encircling the entire circumference of the jejunum at the origin. CT and magnetic resonance imaging scans and angiography showed no apparent tumor lesions. Jejunal stenosis due to inflammatory disease was diagnosed and a jejnectomy was performed. Upon laparotomy, a narrowing, which encircled the entire circumference of the jejunum about 6 cm from the Treitz' ligament and shortened the jejunum, was seen. In addition a swollen lymph node with the size of tip of the small finger was present. On histopathological studies, granuloma with Langhans' type giant cells was identified in both the stenosis and lymph node, and jejunal tuberculosis was diagnosed.<br>In the treatment of intestinal obstruction without tumor lesions, it is important to keep some inflammatory disorders, especially intestinal tuberculosis, in mind.

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