Kaushik S P, Bassett M L, McDonald C, Lin B P, Bokey E L
Gastroenterology Unit, Woden Valley Hospital, ACT, Australia.
J Gastroenterol Hepatol. 1996 Jun;11(6):532-4. doi: 10.1111/j.1440-1746.1996.tb01697.x.
A male Caucasian presented with abdominal pain and a right iliac fossa mass. There were no risk factors for Mycobacterium tuberculosis infection. He was investigated by upper and lower gastrointestinal endoscopy, chest and small bowel radiology. The latter showed stricturing of the third and fourth parts of the duodenum, mid-jejunum and terminal ileum. Biopsies were non-specific and he was thought to have Crohn's disease. Subsequent treatment with corticosteroids resulted in improved well being and weight gain; however, the patient demonstrated disease progression with the development of complex fistulae and Escherichia coli septicaemia. At surgery the patient was found to have an ileal inflammatory mass with fistulae to the sigmoid colon. The terminal ileum, fistulae and a segment of colon were resected. Treatment with anti-tuberculous drugs ensued and the patient is now asymptomatic after 15 months of follow-up. This case serves to highlight the difficulty in making the diagnosis of gastrointestinal tuberculosis, a disease that may mimic Crohn's disease, and the need for caution in the use of corticosteroids in any disease in which tuberculosis enters into the differential diagnosis. The role of surgery in making the diagnosis and managing the complications, in conjunction with anti-tuberculous drugs, and the prospect of cure are exemplified by this case.
一名白人男性因腹痛和右下腹肿块就诊。他没有感染结核分枝杆菌的危险因素。对其进行了上、下消化道内镜检查以及胸部和小肠影像学检查。后者显示十二指肠第三和第四部分、空肠中段和回肠末端出现狭窄。活检结果无特异性，当时认为他患有克罗恩病。随后使用皮质类固醇治疗使患者状况改善且体重增加；然而，患者病情仍进展，出现了复杂的瘘管和大肠杆菌败血症。手术时发现患者有回肠炎性肿块并伴有通向乙状结肠的瘘管。切除了回肠末端、瘘管和一段结肠。随后进行了抗结核药物治疗，经过15个月的随访，患者目前无症状。该病例凸显了胃肠道结核诊断的困难，这种疾病可能酷似克罗恩病，同时也强调了在结核进入鉴别诊断的任何疾病中使用皮质类固醇时需谨慎。本病例还举例说明了手术在诊断和处理并发症方面的作用，以及与抗结核药物联合使用时治愈疾病的前景。
