Essig K M, Kienast K, Ferlinz R
III. Medizinische Klinik und Poliklinik, Universitätskliniken Mainz.
Pneumologie. 1997 Aug;51(8):828-31.
We report on a 30-year old patient suffering from acute abdomen. X-ray examinations (abdomen photograph, passage of contrast medium) showed an obstructive ileus of the small bowel. Exploratory laparatomy revealed an obstruction of the small bowel by means of masses of lymphatic nodes as part of a mesenteric lymphadenopathy. M. tuberculosis was identified as growing in cultures of peritoneal smears and material of lymphatic nodes. The retrospective examination of the pre-operative x-ray photographs of the chest showed an old primary complex of the lung. A combination of four antituberculotic drugs: Rifampicin, ethambutol, isoniazid and pyrazinamid was administered following the concept of a 6-month regimen. This treatment was successful: CT-scans of the abdomen showed a reduction of the mesenterial lymphadenopathy and the disappearance of the duodenal impression in the follow-up after 4 weeks of therapy. The abdominal TBC represents a severe disease requiring a differential diagnostic distinction from other abdominal diseases such as ileitis terminalis, Crohn's disease, neoplass as especially gastrointestinal lymphomas, giardiasis, amoebiasis and yersinia enterocolitis. The disease has a special importance among immigrant populations.
我们报告了一名30岁患有急腹症的患者。X线检查（腹部照片、造影剂通过情况）显示小肠梗阻。剖腹探查发现小肠被大量淋巴结阻塞，这是肠系膜淋巴结病的一部分。在腹膜涂片和淋巴结材料培养中发现结核分枝杆菌生长。术前胸部X线照片的回顾性检查显示肺部有陈旧性原发综合征。按照6个月疗程的方案，给予利福平、乙胺丁醇、异烟肼和吡嗪酰胺四种抗结核药物联合治疗。该治疗取得成功：治疗4周后的随访腹部CT扫描显示肠系膜淋巴结病减轻，十二指肠压迹消失。腹部结核是一种严重疾病，需要与其他腹部疾病进行鉴别诊断，如末端回肠炎、克罗恩病、肿瘤尤其是胃肠道淋巴瘤、贾第虫病、阿米巴病和耶尔森菌小肠结肠炎。该疾病在移民人群中具有特殊重要性。
