胃出口梗阻：一例罕见的原发性十二指肠结核病例。
Gastric outlet obstruction: an unusual case of primary duodenal tuberculosis.
作者信息
Kalpande Sanket, Pandya Jayashri Sanjay, Tiwari Ajeet, Adhikari Devbrata
机构信息
Department of General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
出版信息
BMJ Case Rep. 2017 Mar 24;2017:bcr2016217966. doi: 10.1136/bcr-2016-217966.
BACKGROUND
Tuberculosis is a major health problem worldwide. Gastrointestinal tuberculosis presenting as isolated involvement of the duodenum is a rare case.
CASE PRESENTATION
A 13 year male, presented with features of gastric outlet obstruction. CT enterography scan showed circumferential mural thickening in first and second part of duodenal junction causing luminal narrowing. Upper GI endoscopy confirmed the narrowing of D1-D2 junction. Duodenal biopsy showed duodenitis with negative result for AFB stain, . Patient underwent roux-en-y gastro-jejunostomy. Histo-pathological findings were consistent with tuberculosis. Patient was started on AKT and discharged. At 3 months follow up; patient asymptomatic.
CONCLUSION
The unusual location of gastrointestinal tuberculosis, lack of specific signs and symptoms, radiological studies and endoscopy findings makes diagnosis a challenge. The treatment of duodenal tuberculosis is still medical and surgery should be reserved for emergency like gastric outlet obstruction causing nutritional compromise.
背景
结核病是全球主要的健康问题。仅表现为十二指肠受累的胃肠道结核是一种罕见病例。
病例报告
一名13岁男性，表现为胃出口梗阻的症状。CT小肠造影扫描显示十二指肠交界处第一和第二部分的环形壁增厚，导致管腔狭窄。上消化道内镜检查证实十二指肠球部至降部交界处狭窄。十二指肠活检显示为十二指肠炎，抗酸杆菌染色结果为阴性。患者接受了胃空肠吻合术。组织病理学检查结果与结核病相符。患者开始接受抗结核治疗并出院。在3个月的随访中，患者无症状。
结论
胃肠道结核的不寻常位置、缺乏特异性体征和症状、影像学检查和内镜检查结果使得诊断具有挑战性。十二指肠结核的治疗仍以药物治疗为主，手术应仅用于如胃出口梗阻导致营养状况受损等紧急情况。
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