Shah Mudassar, Wani Munir A
Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Saudi J Med Med Sci. 2017 Sep-Dec;5(3):275-277. doi: 10.4103/1658-631X.213301. Epub 2017 Aug 21.
Spontaneous enterocutaneous fistula can occur in patients with Crohn's disease, malignancy, typhoid or radiation exposure. Tuberculosis is a rare cause of enterocutaneous fistula. A 60-year-old female with no significant previous history presented with a feculent discharge from a fistulous opening on the right gluteal region for 3 months. There was also a history of extrusion of multiple worms through the opening. Abdominal ultrasonography showed no intraperitoneal fluid collections. A contrast-enhanced computed tomography of the abdomen, magnetic resonance (MR) imaging and MR fistulogram revealed cortical destruction of the right iliac bone with fluid coursing along a tract, from the small gut loops attached to bone internally through the iliac bone to the soft tissues in the right gluteal region before opening on the skin. A biopsy from the tissue of the fistula site revealed tuberculosis. The patient responded well to conservative management and was discharged after 4 weeks.
自发性肠皮肤瘘可发生于克罗恩病、恶性肿瘤、伤寒或接受过放疗的患者。结核病是肠皮肤瘘的罕见病因。一名60岁女性，既往无重大病史，右侧臀区瘘口有粪便样分泌物3个月。既往还有从瘘口排出多条蠕虫的病史。腹部超声未显示腹腔积液。腹部增强计算机断层扫描、磁共振成像及磁共振瘘管造影显示右髂骨皮质破坏，有液体沿一条通道流动，从内部附着于骨的小肠袢经髂骨至右侧臀区软组织，然后在皮肤开口。瘘口部位组织活检显示为结核病。患者经保守治疗后反应良好，4周后出院。
