Small Intestinal Tuberculosis Complicated with Intestinal Obstruction and Perforation: A Case Report

小腸結核症合併腸阻塞及腸穿孔：一病例報告

黃森亭(Sen-Ting Huang) ； 王鴻昌(Hong-Chung Wang) ； 盧朝勇(Jau-Yeong Lu)

《胸腔醫學》 18卷3期 (2003/06) Pp. 259-263

https://doi.org/10.29806/TM.200306.0010

摘要

腸道結核症並不常見，而且因為沒有特異性的症狀，所以，診斷並不容易，通常需要臨床醫師高度懷疑此病的可能性，進而獲得適當的檢體來得到確定診斷。一名年齡六十四歲之病人沒有任何潛在性的疾病，這次因為發燒及呼吸急促而住院，胸部X光顯示兩側廣泛性肺泡浸潤增加，經氣管鏡切片檢查證實是肺結核，於是投與抗結核藥物治療，病人的症狀也因而獲得緩解。但在抗結核藥物治療四週後，突然發生劇烈腹痛，腹部電腦斷層顯示在迴腸末端發生腸阻塞，於是緊急實施剖腹探查術，病理切片證實為迴腸結核症合併腸阻塞及腸穿孔。這個經驗告訴我們，一位罹患肺結核的病人在接受適當的治療下，倘若有急性腹痛的症狀出現，一定要把腸結核症列入鑒別診斷，以便能早期診斷並視病情作選擇性手術，而減少發生腸穿孔併發症。

關鍵字

結核症 ； 腸道結核 ； 腸穿孔 ； 腹膜炎

並列摘要

Small intestinal tuberculosis (TB) is an uncommon disease, and is difficult to diagnose because its symptoms and signs are nonspecific. We can only depend on a high degree of suspicion of the possibility of intestinal TB, and subsequently obtain appropriate specimens for the definite diagnosis. We herein report a 64-year-old male patient who denied any previous history of disease. He initially complained of fever and shortness of breath. The chest radiograph revealed increasing bilateral diffuse alveolar infiltrates. Pulmonary TB was diagnosed by bronchoscopic biopsy. Four-combined anti-TB therapy was administrated for about 4 weeks and clinical symptoms showed obvious improvement. Unfortunately, right upper abdominal pain developed suddenly and rapidly progressed to diffuse abdominal pain. The computed tomography of the abdomen revealed dilatation of the small bowel with an air-fluid level and intestinal obstruction in the terminal ileum. An emergency exploratory laparotomy was done. Tuberculosis of the terminal ileum with bowel perforation and peritonitis were diagnosed. Intestinal TB still needs to be considered for the differential diagnosis for a patient with pulmonary TB under an anti-tuberculosis treatment, who complains of any symptoms or signs of acute abdomen.

並列關鍵字

tuberculosis ； small intestinal tuberculosis ； bowel perforation ； peritonitis