Aranda Eliana Elisabet, Luján Sánchez Ana María, Zago Daniel Enrique, Ferradas Francisco Omar, Torres Ricardo
Acta Gastroenterol Latinoam. 2015 Dec;45(4):312-5.
The gastrointestinal commitment is the six most frequent location of extrapulmonary tuberculosis. Often its acute complications constitute the main presentation form due to a late diagnosis.
To review the presentation of gastrointestinal tuberculosis as perforative acute abdomen and surgical resolution.
Case 1. A 31 year old female, with newly diagnosed pulmonary tuberculosis, discontinuous treatment. Two month later presents with peritonitis acute abdomen. Laparotomy is done being stated intestinal perforations. They performed resection and anastomosis terminal. The treatment with ant tuberculosis starts. Good evolution. Case 2. A 30 years male patient, HIV and pulmonary tuberculosis with discontinuous treatment. He was admitted with abdominal pain and generalized peritoneal reaction. Intestinal perforations is found at laparotomy. Biopsy and raffia intestinal is performed. Four days later suture dehiscence and new intestinal perforations are found. Resection and ileostomy is performed. It evolution with distress and death. In both cases histopathology confirmed intestinal tuberculosis.
Because of the nonspecific symptoms of intestinal tuberculosis, is common the diagnosis through their acute complications and these are potentially lethal especially in immunocompromised patients. The prompt treatment with anti tuberculosis drugs is the limiting in elective surgery in selected cases.
胃肠道是肺外结核第六大常见发病部位。由于诊断延迟,其急性并发症常构成主要表现形式。
回顾胃肠道结核表现为穿孔性急腹症及手术治疗情况。
病例1. 一名31岁女性,新诊断为肺结核,治疗不连续。两个月后出现腹膜炎性急腹症。行剖腹探查术,发现肠道穿孔。进行了肠切除及端端吻合术。开始抗结核治疗。病情好转。病例2. 一名30岁男性患者,患有艾滋病和肺结核,治疗不连续。因腹痛和全身性腹膜反应入院。剖腹探查时发现肠道穿孔。进行了活检及肠修补术。四天后发现缝线裂开及新的肠道穿孔。进行了肠切除及回肠造口术。病情恶化并死亡。两例组织病理学均确诊为肠结核。
由于肠结核症状不具特异性,常通过其急性并发症进行诊断,这些并发症具有潜在致死性,尤其是在免疫功能低下患者中。在特定病例中,及时使用抗结核药物是选择性手术的限制因素。