Intestinal Tuberculosis: A Case Series from a Single Center over 15 Years

腸結核：單一醫學中心十五年間的病例系列研究

Li-Ning Hsu(徐利寧) ； Ping-Wei Lin(林秉緯) ； Cheng-Ta Lai(賴正大) ； Hsi-Hsien Hsu(許希賢) ； Ching-Kuo Yang(楊靖國) ； Jian-Syun Chen(陳建勳) ； Wen-Chun Sun(孫文俊) ； Wai-Hung Leung(梁偉雄) ； Chien-Kuo Liu(劉建國)

《中華民國大腸直腸外科醫學會雜誌》 33卷4期 (2022/12) Pp. 230-236

https://doi.org/10.6312/SCRSTW.202212_33(4).11127

摘要

Purpose. The nonspecific features of intestinal tuberculosis increase the difficulty of accurate diagnosis. This study aimed to familiarize surgeons with common presentations of intestinal tuberculosis and to increase vigilance for this disease. Methods. A retrospective case series was conducted, collecting data from consecutive patients with intestinal tuberculosis from April 2005 to May 2019 in a single institution. Patients’ symptoms, indications for surgery, and complications were recorded as well as the final histology, lesion locations and methods of investigation. Results. A total of 14 cases was found in the 15-year study period. The cardinal symptoms were abdominal pain, diarrhea, and GI bleeding. The ileocecal region was the most common location. Most cases underwent surgery as a result of obstruction and diagnostic confirmation. Two cases received surgery because of perforation and one had complication-associated mortality. CT was performed in 13 cases and 11 underwent endoscopy. Histology showed typical granulomatous formation in 11 cases. Tuberculosis polymerase chain reaction (TB PCR) was performed in 13 cases. Pulmonary tuberculosis was confirmed in 7 cases and 13 cases received anti-tuberculosis treatments. Conclusion. A high index of suspicion is essential for early diagnosis of intestinal tuberculosis. Thorough history taking, detailed endoscopic or radiologic exams, and careful histological study, are all paramount for making an accurate diagnosis.

關鍵字

Intestinal tuberculosis ； Diagnosis ； Conservative treatment ； Surgery

並列摘要

目的：腸結核的非專一性表現會使準確診斷變得困難。本篇的目標是幫助外科醫師熟悉腸結核的常見表徵並增加疾病的警覺性。方法：本篇為回溯性病例系列，資料蒐集自單一醫學中心，時間從2005年四月到2019年五月。記錄症狀、手術適應症、併發症、最終病理結果、病灶位置和診斷方法。結果：十五年研究期間共有十四個病例。主要症狀有腹痛、腹瀉和腸胃道出血。大部分病例接受手術，適應症是阻塞和診斷。兩個病例經歷手術是因為穿孔，且其中一位死亡。迴盲瓣附近的位置占大多數，各占大約43個百分比。十三個病例執行電腦斷層，十一個病例做大腸鏡。十一個病理報告顯示典型的肉芽腫構造。十三個病例有接受結核菌核酸增幅檢驗。七個病例被證實有肺結核。十三個病例有接受抗結核菌治療。結論：高度懷疑對於早期診斷腸結核是必須的。包括過去病史在內，全面性的臨床檢查是至關重要的。本篇呈現我們中心的腸結核病例經驗。雖然資料簡短而有限，我們期望能在本篇的基礎上，對未來進行更詳細的分析以供研究及參考。

並列關鍵字

腸結核 ； 診斷 ； 保守治療 ； 手術