Breiter J R, Hajjar J J
Am J Gastroenterol. 1981 Oct;76(4):369-73.
Segmental tuberculosis of the colon is a rare clinical entity. In the absence of pulmonary or ileocecal involvement, colonic tuberculosis may be difficult to differentiate from neoplasm or Crohn's disease by symptomatic and radiological means. Colonoscopy and biopsy can, however, establish the diagnosis and prevent operative intervention, as indicated in the present report. A patient with a radiologically demonstrated strictured lesion of the sigmoid colon was found at colonoscopy to have several hemorrhagic transverse ulcers ranging in diameter between 1-4.5 cm. Multiple target colonoscopic biopsies, specifically from the ulcer beds, revealed necrotizing granulomas and acid-fast bacilli. Antituberculous chemotherapy produced remarkable symptomatic, radiographic and endoscopic improvements and averted exploratory laparotomy for the establishment of the diagnosis. This case report points out the importance of colonoscopic biopsy as a useful diagnostic modality in this disease.
结肠节段性结核是一种罕见的临床病症。在没有肺部或回盲部受累的情况下，结肠结核可能难以通过症状和影像学手段与肿瘤或克罗恩病相鉴别。然而，正如本报告所示，结肠镜检查及活检能够确诊并避免手术干预。一名经影像学检查显示乙状结肠有狭窄病变的患者，在结肠镜检查时发现有多个直径在1至4.5厘米之间的出血性横向溃疡。多次靶向结肠镜活检，特别是取自溃疡底部的活检，显示有坏死性肉芽肿和抗酸杆菌。抗结核化疗使症状、影像学及内镜检查结果有了显著改善，避免了为明确诊断而进行的剖腹探查术。本病例报告指出了结肠镜活检作为该病一种有用诊断方法的重要性。
