Yokoba M, Takahashi T, Yosii A, Kitsuda T, Bessho T, Misu Y, Tomita T
Department of Internal Medicine, Isehara Kyodo Hospital, Kanagawa, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Apr;34(4):487-93.
A 27-year-old man was admitted to our hospital because of abdominal pain and vomiting. A radiograph of the chest revealed widening of the right superior part of the mediastinum, and an abdominal radiograph showed many air-fluid levels. A computed tomographic scan of the chest revealed a solitary nodule in the right anterior lobe of the lung, and right paratracheal lymphadenopathy. Ileus was diagnosed and a nasogastric tube was inserted. The patient's condition gradually worsened, and on hospital day 17 a laparotomy was performed. Operative findings were significant for numerous, white nodules all over the peritoneum, omentum, and mesentery, which ranged from miliary to rice grain-sized. Examination of an omental specimen revealed noncaseating granulomas with Lang hans' giant cells. The polymerase chain reaction was used to examine fluid from the nasogastric tube used before surgery, and on hospital day 40 that fluid was found to be positive for Mycobacterium tuberculosis. M. tuberculosis was also cultured from the fluid. From these findings, we concluded that this was a case of pulmonary tuberculosis manifesting predominantly as ileus secondary to tuberculous peritonitis. Anti-tuberculosis therapy consisting of isoniazid, rifampin, and ethambutol was started postoperatively. On repeat laparoscopy 224 days later, no white nodules were seen. A computed tomographic scan of the chest revealed that the right paratracheal lymphadenopathy was markedly reduced, and the solitary nodule in the right anterior lobe of the lung was almost gone. Few cases of young people with pulmonary tuberculosis manifesting primarily as ileus have been reported. Tuberculosis should be included in the differential diagnosis in patients presenting with ileus.
一名27岁男性因腹痛和呕吐入院。胸部X线片显示纵隔右上部分增宽，腹部X线片显示多个气液平面。胸部计算机断层扫描显示右肺前叶有一个孤立结节以及右气管旁淋巴结肿大。诊断为肠梗阻，并插入了鼻胃管。患者病情逐渐恶化，在住院第17天进行了剖腹手术。手术发现腹膜、大网膜和肠系膜上有大量白色结节，大小从粟粒到米粒不等，这一发现具有重要意义。对大网膜标本的检查发现了含有朗汉斯巨细胞的非干酪性肉芽肿。使用聚合酶链反应检测手术前使用的鼻胃管中的液体，在住院第40天发现该液体结核分枝杆菌呈阳性。液体中也培养出了结核分枝杆菌。根据这些发现，我们得出结论，这是一例以结核性腹膜炎继发肠梗阻为主要表现的肺结核病例。术后开始使用异烟肼、利福平和乙胺丁醇组成的抗结核治疗。224天后再次进行腹腔镜检查时，未发现白色结节。胸部计算机断层扫描显示右气管旁淋巴结肿大明显减轻，右肺前叶的孤立结节几乎消失。很少有年轻人肺结核主要表现为肠梗阻的病例报道。肠梗阻患者的鉴别诊断应包括结核病。
