Park Chan Sung, Seo Kwang Won, Park Chang Ryul, Nah Yang Won, Suh Jae Hee
Chan Sung Park, Kwang won Seo, Department of Internal medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea.
World J Gastrointest Surg. 2014 Dec 27;6(12):253-8. doi: 10.4240/wjgs.v6.i12.253.
Gastric perforation and tuberculous bronchoesophageal fistula (TBEF) are very rare complications of extrapulmonary tuberculosis (TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multidrug-resistant tuberculosis strain in a non-acquired immune deficiency syndrome male patient. The patient underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy and feeding jejunostomy during intravenous treatment with anti-TB medication, and esophageal reconstruction with colonic interposition and jejunocolostomy were performed successfully after a full course of anti-TB medication. Though recent therapies for TBEF have favored medication, patients with severe stenosis or perforation require surgery and medication with anti-TB drugs based upon adequate culture and drug susceptibility testing.
胃穿孔和结核性支气管食管瘘（TBEF）是肺外结核（TB）非常罕见的并发症。我们报告一例非获得性免疫缺陷综合征男性患者，因耐多药结核菌株导致的肺结核合并TBEF和胃穿孔。患者在接受抗结核药物静脉治疗期间接受了全胃切除术加Roux-en-Y食管空肠端侧吻合术和空肠造口术，在完成抗结核药物全疗程治疗后成功进行了结肠代食管术和空肠结肠吻合术的食管重建。尽管近期对TBEF的治疗倾向于药物治疗，但对于严重狭窄或穿孔的患者，需要根据充分的培养和药敏试验进行手术及抗结核药物治疗。
