Wei Jiang-Peng, Wu Xiao-Yan, Gao Sen-Yang, Chen Qiu-Yu, Liu Tong, Liu Gang
From the Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
Medicine (Baltimore). 2016 Jan;95(1):e2436. doi: 10.1097/MD.0000000000002436.
The differential diagnosis of Crohn's disease (CD) and intestinal tuberculosis (ITB) remains difficult as the clinical symptoms of the 2 digestive diseases are so similar. Here we report a case where a patient was initially misdiagnosed with ITB prior to the correct CD diagnosis. The 46-year-old male patient was hospitalized elsewhere for pain in the right lower abdomen and underwent an appendectomy. The pathological diagnosis was ITB and the patient was administered antituberculosis therapy for 1 year. Afterward, the patient was readmitted to the hospital for a right lower abdominal mass. A computed tomography scan revealed intestinal gas, fistula, and abdominal mass. We performed a right hemicolectomy on the patient. Postoperatively, we diagnosed the patient with CD, based on patient history and pathological examination. According to the CD active index (CDAI), the patient was at high risk and began treatment with infliximab. The patient has remained in complete remission and made a good recovery after 8-months follow-up. We compared this case with the results of a literature review on the misdiagnosis between CD and ITB (26 previously reported cases) to determine the characteristics of misdiagnosed cases. We found that distinguishing between ITB and CD is difficult because of their varied clinical presentation, nonspecific investigative tools, and profound similarities even in pathological specimens. Although a CT scan to determine the morphology of the bowel wall is a key for correct diagnosis, each case still poses challenges for diagnosis and administrating the appropriate treatment.
由于这两种消化系统疾病的临床症状非常相似，克罗恩病（CD）和肠结核（ITB）的鉴别诊断仍然困难。在此，我们报告一例患者，最初被误诊为肠结核，之后才确诊为克罗恩病。这位46岁的男性患者因右下腹部疼痛在其他医院住院，并接受了阑尾切除术。病理诊断为肠结核，患者接受了1年的抗结核治疗。此后，患者因右下腹部肿块再次入院。计算机断层扫描显示肠道积气、瘘管和腹部肿块。我们对该患者实施了右半结肠切除术。术后，根据患者病史和病理检查，我们诊断该患者为克罗恩病。根据克罗恩病活动指数（CDAI），该患者处于高风险状态，开始使用英夫利昔单抗进行治疗。经过8个月的随访，患者一直处于完全缓解状态，恢复良好。我们将该病例与关于克罗恩病和肠结核误诊的文献综述结果（先前报道的26例病例）进行比较，以确定误诊病例的特征。我们发现，由于肠结核和克罗恩病临床表现多样、检查手段缺乏特异性，甚至在病理标本中也有许多相似之处，因此很难将二者区分开来。尽管通过CT扫描来确定肠壁形态是正确诊断的关键，但每个病例在诊断和给予适当治疗方面仍然存在挑战。
