Bromberg S H, Faroud S, de Castro F F, Morrone N, de Godoy A C, França L C
Hospital do Servidor Público Estadual 'Francisco Morato de Oliveira', São Paulo, SP.
Rev Assoc Med Bras (1992). 2001 Apr-Jun;47(2):125-8. doi: 10.1590/s0104-42302001000200030.
Isolated ileocecal involvement by tuberculosis in the absence of pulmonar disease is rare in Brasil, therefore causes a diagnostic dilemma as it mimics colonic malignancy and Crohn's disease.
Between 1969 and 1989, eight patients with isolated hypertrophic ileocecal tuberculosis were treated by surgery in the Gastroenterology Surgery Department of the HSPE-FMO. The most common complaint among them was abdominal pain (100%) with associated symptoms of weight loss (62.5%); nausea, vomiting, fever and general weekness appeared in half of the patients. A right iliac fossa mass was present in seven (87.5% ) of them. The mean duration of symptoms was 14.7 month (range 5-36 months). In all eight patients chest x-rays were negative for tuberculosis. Barium contrast studies showed abnormalities in all cases, but these could not be distinguished from carcinoma. Colonoscopy was helpful in establishing the diagnosis of suboclusive lesions of the ileocecal regions in three patients. Tuberculosis diagnosis was suspected in two of them because ofr the presence of granulomas in colonic biopsy material.
Six patients were submitted to elective right hemicolectomy. The two remaining with suspect of tuberculosis were operated with signals of intestinal occlusion, and underwent a limited ileocaecal resection. The positive diagnosis of intestinal tuberculosis was made in all the patients by identification of acid-fast bacilli and by the presence of caseating granulomas in intestinal or lymph node tissue on histological examination. The outcome in all of them was favorable. They received treatment with three antituberculosis drugs over a twelve month period.
Hypertrophic ileocecal tuberculosis must still be considered in the differential diagnosis of abdominal pathology localized in the right lower quadrant.
在巴西，无肺部疾病的孤立性回盲部结核受累情况罕见，因此会造成诊断难题，因为它可模仿结肠恶性肿瘤和克罗恩病。
1969年至1989年间，8例孤立性肥厚性回盲部结核患者在HSPE - FMO胃肠外科接受手术治疗。他们最常见的主诉是腹痛（100%），伴有体重减轻症状（62.5%）；一半患者出现恶心、呕吐、发热和全身虚弱。其中7例（87.5%）存在右下腹包块。症状的平均持续时间为14.7个月（范围5 - 36个月）。所有8例患者胸部X线检查均未发现结核。钡剂造影检查在所有病例中均显示异常，但无法与癌相鉴别。结肠镜检查有助于3例患者确立回盲部亚闭塞性病变的诊断。其中2例因结肠活检材料中存在肉芽肿而怀疑为结核。
6例患者接受了择期右半结肠切除术。另外2例怀疑为结核的患者因出现肠梗阻体征而接受手术，行有限的回盲部切除术。所有患者通过鉴定抗酸杆菌以及组织学检查发现肠道或淋巴结组织中存在干酪样肉芽肿而确诊为肠结核。他们的预后均良好。他们接受了为期12个月的三种抗结核药物治疗。
在右下象限局限性腹部病变的鉴别诊断中，仍必须考虑肥厚性回盲部结核。
