- 期刊
腸道結核病與右下腹痛：病例報告
Tuberculous Colitis and Right Lower Quadrant Abdominal Pain: A Case Report
摘要
腸道結核（病）在台灣並不多見，臨床表現變化多端，而且因爲沒有特異性的症狀徵候，診斷上並不容易。最常見症狀是右下腹痛或腫塊，常被誤爲腸癌或闌尾炎。因此常常是在剖腹探查術或大腸鏡檢查後，取得適當的檢體，才得到確定診斷。本研究報告一位67歲老年女性，患有膽結石、長期便秘，最近一週出現右下腹痛，腹部觸診發現右下腹腫塊。經過腹部超音波、下消化道攝影、電腦斷層攝影等影像學檢查，經皮穿刺切片的病理組織發現爲腸道結核菌感染。以抗結核藥物治療兩週後症狀緩解。抗結核藥物治療一年後停藥，病人沒有再出現症狀，也避免了不必要的手術。本文可獲此結論：(1)右下腹痛可將腸道結核（病）列入鑑別診斷對象；(2)對老年病患，儘量優先考慮以侵襲性較小、危險性較低的方式來介入檢查及治療，以維護生活品質及其健康功能。
並列摘要
Tuberculous colitis is an uncommon morbidity in Taiwan. Clinical diagnosis is difficult to set for the diversified manifestations and absence of specific characteristics. The most common one is right lower quadrant pain that is usually overlooked or mistaken as colon cancer or appendicitis. The study reports a 67-year-old female patient, whose past history indicates gall bladder stone and chronic constipation. Her chief complaints were right lower abdominal pain for a week. The physical examinations found a palpable mass at right lower quadrant area. We arranged image studies such as ultrosonography, gastrointestinal contrast studies and computed tomography (CT). We confirmed the diagnosis by trans-abdominal percutaneous needle biopsy under CT guide. The pathologic specimen proved to be ”Tuberculous colitis.” The symptoms resolved after two weeks of anti-tuberculosis (TB) medication administrated. The patient recovered completely after one year of scheduled anti-tuberculosis (TB) treatment. We can conclude two fold: (1). ”Tuberculous colitis” can be taken into thinking during the differentiation of right lower quadrant pain; (2). Doctors should proritizedly consider the less invasive, lower risk medical procedure for aged patient so as to protect their life quality and health function.