A case of intestinal tuberculosis complicated by miliary tuberculosis

파종성 폐결핵을 가진 남아에서 합병된 장결핵 1례

  • Chung, Min Kook (Department of Pediatrics, Han-il General Hospital) ;
  • Choi, Jeong Ho (Department of Pediatrics, Han-il General Hospital) ;
  • Yoo, Jung Suk (Department of Pediatrics, Han-il General Hospital) ;
  • Ahn, Seung In (Department of Pediatrics, Han-il General Hospital) ;
  • Lee, Jin (Department of Pediatrics, Han-il General Hospital) ;
  • Kim, Bong Lim (Department of Pediatrics, Han-il General Hospital) ;
  • Kim, Jung A (Department of Pediatrics, Han-il General Hospital) ;
  • Chang, Jin Keun (Department of Pediatrics, Han-il General Hospital)
  • 정민국 (한일병원 소아과) ;
  • 최정호 (한일병원 소아과) ;
  • 유정석 (한일병원 소아과) ;
  • 안승인 (한일병원 소아과) ;
  • 이진 (한일병원 소아과) ;
  • 김봉림 (한일병원 소아과) ;
  • 김정아 (한일병원 소아과) ;
  • 장진근 (한일병원 소아과)
  • Received : 2006.07.25
  • Accepted : 2006.09.12
  • Published : 2006.11.15

Abstract

Intestinal tuberculosis presents with nonspecific and variable clinical manifestations. It is rarely seen in current clinical practice and the diagnosis may be missed or confused with many other disorders such as Crohns disease and intestinal neoplasms. The route of infection by tuberculous enteritis is variable and the treatment regimens used for treating pulmonary tuberculosis are generally effective for tuberculous enteritis as well. Uncomplicated tuberculous enteritis can be managed with a nine to 12- month course of antituberculous chemotherapy. If not treated early, the prognosis for intestinal tuberculosis is poor, with an overall mortality of between 19 percent and 38 percent. However, 90 percent of patients will respond to medical therapy alone if started early. Therefore, early detection and treatment is essential. Here we report a case of intestinal tuberculosis secondary to miliary tuberculosis.

소아에 있어서 복부 및 위장관 결핵은 매우 드문 질환이며 임상증상도 복통, 설사, 체중감소, 발열 등 비특이적이어서 크론병, 맹장염 및 다른 위장관 질환의 증상과 크게 다르지 않아 복부 질환의 진단에 있어 간과하기 쉽다. 특히 결핵성 장염은 사망률이 19-38%에 이르지만 조기에 진단, 치료하면 예후가 좋아 조기 진단의 중요성이 높다. 저자들은 복부팽만, 발열을 주소로 내원한 환아에게 속립성 폐결핵에 합병된 결핵성 장염 1례를 경험하였기에 보고하는 바이며, 아직도 결핵 유병율이 높은 우리나라에서는 위장관 증세를 호소하는 환아에게 위장관 결핵의 가능성을 고려해야 하겠다.

Keywords

References

  1. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993;88:988-99
  2. Vanderpool DM, O' Leary JP. Primary tuberculous enteritis. Surg Gynecol Obstet 1988;167:167-73
  3. Bhargava DK, Shriniwas, Chawla TC, Tandon BN, Kapur BM. Intestinal tuberculosis: bacteriological study of tissue obtained by colonoscopy and during surgery. J Trop Med Hyg 1985;88:249-52
  4. Ibrarullah M, Mohan A, Sarkari A, Srinivas M, Mishria A, Sundar TS. Abdominal tuberculosis : diagnosis by laparoscopy and colonoscopy. Trop Gastroenterol 2002;23:150-3
  5. Lane JE, Barron TD, Solis MM, Tench DW, Stephens JL. Tuberculous enteritis: a case report. Am Surg 2000;66: 683-5
  6. Ahmed FB. Tuberculous enteritis. BMJ 1996;313:215-7 https://doi.org/10.1136/bmj.313.7051.215
  7. Sherman S, Rohwedder JJ, Ravikrishnan KP, Weg JG. Tuberculous enteritis and peritonitis: Report of 36 general hospital cases. Arch Intern Med 1980;140:506-8 https://doi.org/10.1001/archinte.140.4.506
  8. Rankine JA. Tuberculosis of the ileocecal area. J Int Coll Surg 1952;18:202
  9. Paustian FF, Bockus HL. So-called primary ulcerohypertrophic ileocecal tuberculosis. Am J Med 1959;27:509-18 https://doi.org/10.1016/0002-9343(59)90016-6
  10. Moss JD, Knauer CM. Tuberculous enteritis. A report of three patients. Gastroenterology 1973;65:959-66
  11. Hill GS Jr, Tabrisky J, Peter ME. Tuberculous enteritis. West J Med 1976;124:440-5
  12. Homan WP, Grafe WR, Dineen P. A 44-year experience with tuberculous enterocolitis. World J Surg 1977;2:245-50
  13. Bhansali SK. Abdominal tuberculosis: experiences with 300 cases. Am J Gastroenterol 1977;67:324-37
  14. Lambrianides AL, Ackroyd N, Shorey BA. Abdominal tuberculosis. Br J Surg 1980;67:887-9. https://doi.org/10.1002/bjs.1800671216
  15. Porter Jm, Snowe RJ, Silver D. Tuberculous enteritis with perforation and abscess formation in childhood. Surgery 1972;71:254-7
  16. Novis BH, Bank S, Marks IN. Gastrointestinal and peritoneal tuberculosis: a study of cases at Groote Schuur Hospital; 1962-1971. S Afr Med J 1973;47:365-72
  17. Klimach OE, Ormerod LP. Gastrointersinal tuberculosis: A retrospective review of 109 cases in a district general hospital. Q J Med 1985;56:569-78