Dahiya Divya, Garg Mandeep, Kaman Lileswar, Rana Surinder, Rao Chalapathi, Behera Arunanshu
Pol Przegl Chir. 2013 Aug;85(8):464-6. doi: 10.2478/pjs.2013.85.8.464.
Extrapulmonary tuberculosis is rare and often difficult to diagnose infection. We report a case of duodenal tuberculosis, who presented with upper gastrointestinal symptoms. There was evidence of obstruction in the third part of duodenum (D3) on oesophagogastro endoscopy, barium meal follow through and CT scan of abdomen. On exploration there was thickening of D3 and D4 causing luminal obstruction. Resection of stricturous segment with end-to-side duodenojejunostomy was done. Biopsy of the diseased segment was tubercular. Antitubercular treatment was given to the patient for 6 months and he is doing well on follow up (1 year after surgery). Duodenal tuberculosis being the rarest form of intestinal tuberculosis poses great difficulty in diagnosis. High index of suspicion supported by radiological investigation, exploratory laparotomy and histopathological examination of the tissue can only lead to a definitive diagnosis of this rare condition. Treatment is both surgical which involves resection or by-pass for an obstructive lesion and medical which includes antitubercular therapy.
肺外结核较为罕见，且感染常难以诊断。我们报告一例十二指肠结核病例，该患者表现为上消化道症状。食管胃十二指肠镜检查、钡餐造影及腹部CT扫描均显示十二指肠第三部（D3）存在梗阻迹象。手术探查发现D3和D4增厚导致管腔梗阻。行狭窄段切除并十二指肠空肠端侧吻合术。病变部位活检结果为结核。给予患者抗结核治疗6个月，随访（术后1年）情况良好。十二指肠结核是肠结核最罕见的形式，诊断极具难度。高度的怀疑指数，辅以放射学检查、剖腹探查及组织病理检查，才能明确诊断这一罕见病症。治疗方法包括手术治疗（针对梗阻性病变进行切除或旁路手术）和药物治疗（包括抗结核治疗）。
