Miyamoto S, Furuse J, Maru Y, Tajiri H, Muto M, Yoshino M
Department of Internal Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
J Gastroenterol Hepatol. 2001 Feb;16(2):235-8. doi: 10.1046/j.1440-1746.2001.02332.x.
A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and Mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. Biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.
一名22岁男性因疲劳和厌食前来我院（国立癌症中心东医院）就诊。实验室检查显示出梗阻性黄疸的生化“表现”。腹部CT显示胰后区域有一个低密度肿块，伴有多个肝门周围淋巴结肿大。上消化道内镜检查发现十二指肠降部后壁有活动性溃疡，活检标本的组织病理学显示为伴有反应性炎性细胞浸润的溃疡；未检测到肿瘤细胞。通过CT和血管造影已排除肿瘤的可能性。黄疸自行消退，腹部肿块大小逐渐减小。内镜逆行胰胆管造影未显示胰腺疾病的证据；然而，内镜逆行胆管造影显示存在胆总管十二指肠瘘。该患者对结核菌素皮肤试验呈超敏反应，通过聚合酶链反应方法和培养在胃液中成功检测到结核分枝杆菌。在第二次上消化道内镜检查时从十二指肠溃疡获取的活检样本显示为伴有上皮样肉芽肿的慢性炎症，提示为结核病。因此，我们将该病例诊断为伴有胆总管十二指肠瘘的十二指肠结核。据我们所知，尚无十二指肠结核导致胆总管十二指肠瘘的报道。
