癌性腹膜炎との鑑別が困難であった結核性腹膜炎の1例  [in Japanese] A case report of tuberculous peritonitis that was difficult to differentiate from peritonitis carcinomatosa  [in Japanese]

Access this Article

Author(s)

Abstract

肺外結核の一種である結核性腹膜炎はまれな疾患で,全結核の0.04~0.6%を占めるにすぎない.今回,われわれは癌性腹膜炎との鑑別を要し,組織学的に結核性腹膜炎と診断した症例を経験したので報告する.患者は62歳女性,4回経産,下腹部痛と便秘を主訴に当院を受診し,超音波検査およびCTにて腹水を認めた.腹水細胞診は陰性であったが,腹水中のヒアルロン酸とADA(adenosine deaminase)活性が高値を示し,また血清CA125も155.1U/mlと高値であった.しかし炎症所見は軽微で全身状態は良好であった.CT,MRI,PET-CT等の画像検査では,腹膜・胃体部の肥厚,腸間膜リンパ節の小結節などを認めた.われわれは結核性腹膜炎も疑ったが,腹水中の結核菌PCRは陰性で結核と診断をすることはできなかった.癌性腹膜炎,悪性リンパ腫,中皮腫などとの鑑別を要したが,確定診断を得られなかったため腹腔鏡下に腹膜生検を施行した.壁側腹膜と大網・腸管は強固に癒着しており,壁側腹膜・臓側腹膜には粟粒大,黄白色の小結節が多数,び漫性に散在していた.術中迅速病理組織診断にて結核性腹膜炎と診断した.その後,抗結核薬の4剤併用療法(リファンピシン,イソニアジド,ピラジナミド,エタンブトール)を開始し,胸水・腹水は消失し,血清CA125も低下した.原因不明の腹水貯留と腹壁肥厚を認めた場合,癌性腹膜炎と結核性腹膜炎の鑑別のために組織学的検査が必要である.〔産婦の進歩59(3):244-248,2007(平成19年8月)〕<br>

Tuberculous peritonitis is an extrapulmonary tuberculosis, which is a rare disease occupying 0.04∼0.6 % of all types of tuberculosis. Recently, we encountered a case of tuberculous peritonitis, which was differentiated from peritonitis carcinomatosa by histological diagnosis. The patient was a 62-year-old woman (Para IV) who consulted our hospital with chief complains of lower abdominal pain and constipation. Ultrasonography and CT demonstrated ascites. Cytodiagnosis of ascites was negative, but hyaluronic acid and the activity of adenosine deaminase (ADA) in ascites were increased. In addition, serum CA125 was increased to 155.1 U/ml. However, inflammatory findings were slight and the general conditions were also good. Image examinations using CT, MRI and PET-CT demonstrated thickening of the peritoneum and the body of the stomach, and nodules in the mesenteric lymph nodes. Based on these findings, tuberculous peritonitis was initially suspected, but PCR showed that ascites was negative for mycobacterium tuberculosis. Therefore, it became necessary to differentiate this disease from peritonitis carcinomatosa, malignant lymphoma and mesotheliomas. Since it was difficult to establish a definitive diagnosis, laparoscopic biopsy of the peritoneum was performed. Laparoscopy demonstrated that the parietal side of the peritoneum closely adhered to the greater omentum and intestine. Furthermore, a large number of yellow nodules were diffused in the parietal and visceral sides of peritoneum. Based on rapid perioperative histopathological diagnosis, the patient was diagnosed as having tuberculous peritonitis. Then, 4-drug combination therapy (rifampicin, isoniazid, pyradinamide and ethanbutol) was started. As a result, both pleural effusion and ascites disappeared and the serum CA125 was lowered. When the patient demonstrates ascites and peritoneal thickening of unknown origin, physicians should perform a histological examination to differentiate between peritonitis carcinomatosa and tuberculous peritonitis. [Adv Obstet Gynecol,59 (3):244-248,2007 (H19.8)]<br>

Journal

  • ADVANCES IN OBSTETRICS AND GYNECOLOGY

    ADVANCES IN OBSTETRICS AND GYNECOLOGY 59(3), 244-248, 2007

    THE OBSTETRICAL GYNECOLOGICAL SOCIETY OF KINKI DISTRICT JAPAN

Cited by:  3

Codes

  • NII Article ID (NAID)
    130001223188
  • NII NACSIS-CAT ID (NCID)
    AN00099490
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0370-8446
  • NDL Article ID
    8906303
  • NDL Source Classification
    ZS38(科学技術--医学--産婦人科学)
  • NDL Call No.
    Z19-310
  • Data Source
    CJPref  NDL  J-STAGE 
Page Top