wcjd@wjgnet.com世界华人消化杂志2009年8月8日;17(22):2329-2331ISSN1009-3079CN14-1260/R病例报告CASEREPORT肠结核误诊为克罗恩病2例庞智,沈必武,郑家驹庞智,沈必武,郑家驹,江苏省苏州市立医院北区消化内科江苏省苏州市215008作者贡献分布:此课题由庞智设计;病例收集由庞智与沈必武完成;研究过程由庞智与郑家驹操作完成;论文写作由庞智完成.通讯作者:庞智,主任医师,215008,江苏省苏州市广济路242号,江苏省苏州市立医院北区消化内科.pangzhi0273@sina.com电话:0512-62363122传真:0512-65332028收稿日期:2009-04-05修回日期:2009-06-08接受日期:2009-06-15在线出版日期:2009-08-08MisdiagnosisofintestinaltuberculosisasCrohn'sdisease:areportoftwocasesZhiPang,Bi-WuShen,Jia-JuZhengZhiPang,Bi-WuShen,Jia-JuZheng,DepartmentofGastroenterology,SuzhouMunicipalHospital(NorthArea),Suzhou215008,JiangsuProvince,ChinaCorrespondenceto:ZhiPang,DepartmentofGastro-enterology,SuzhouMunicipalHospital(NorthArea),242GuangjiRoad,Suzhou215008,JiangsuProvince,China.pangzhi0273@sina.comReceived:2009-04-05Revised:2009-06-08Accepted:2009-06-15Publishedonline:2009-08-08AbstractTwopatientspreviouslydiagnosedasCrohn'sdiseasewereadmittedtoourhospitalbecauseofrepeateddiarrheaforoneyear.Adefinitediagnosisofintestinaltuberculosiswasmadeonthebasisofpathologicalexamination,chestX-rayandsputumsmeartest.ThisobservationsuggeststhatapriorconsiderationofmanagementoftuberculosisisarelativelysafeprinciplewhenitisdifficulttomakeadifferentialdiagnosisbetweenintestinaltuberculosisandCrohn'sdisease.KeyWords:Intestinaltuberculosis;Crohn'sdisease;Misdiagnosis;PrinciplePangZ,ShenBW,ZhengJJ.MisdiagnosisofintestinaltuberculosisasCrohn'sdisease:areportoftwocases.ShijieHuarenXiaohuaZazhi2009;17(22):2329-2331摘要肠结核患者2例因反复腹泻1年入院,被误诊为克罗恩病.经病理、胸片及痰涂片确诊为肠结核.本文提示肠结核与克罗恩病鉴别诊断困难,暂时不能确诊时,应首先考虑按结核病处理这一相对安全的原则.关键词:肠结核;克罗恩病;误诊;原则庞智,沈必武,郑家驹.肠结核误诊为克罗恩病2例.世界华人消化杂志2009;17(22):2329-2331http://www.wjgnet.com/1009-3079/17/2329.asp0引言肠结核与克罗恩病患者临床表现、内镜及病理学改变极为相似,鉴别诊断十分困难,是临床上一大难题[1].最近,我院收治误诊为克罗恩病的肠结核患者2例,现报道如下.1病例报告病例1:男,43岁,因“中下腹隐痛不适伴腹泻1年,加重1wk”于2007-04-12收治我科.患者1年前无明显诱因出现中下腹隐痛不适,腹泻,每日5-6次,黄色稀便,无脓血和明显黏液,无里急后重感,大便后疼痛缓解.肠镜报告回盲瓣和升结肠黏膜充血水肿,可见多发性散在深溃疡,乙状结肠息肉.病理切片示乙状结肠腺瘤性息肉,回盲瓣及升结肠黏膜慢性炎症.给予口服柳氮磺胺吡啶(3.0g/d),以及支持对症治疗后,症状明显好转,腹部无明显不适,大便次数渐减至每日2次.出院后一直坚持服用SASP.近1wk来腹痛明显加重,腹泻次数每日多达8-10次,无脓血.腹部CT检查,报告回肠,回盲部,盲肠,升结肠等肠壁增厚伴淋巴结肿大.直肠周围低密度脓肿可能.病程中无发热,无咳嗽,无明显盗汗,无胸闷气急,全身乏力,食欲不振,半年内体质量减轻约7kg.有吸烟史20余年,每日约20支.家族中有结核病患者.入院查体:T:36.8℃,P每分76次,R每分18次,BP120/70mmHg,消瘦,全身浅表淋巴结不肿大,双肺呼吸音清,未闻及明显干湿罗音.心律齐,未闻及杂音.腹部平坦,柔软,全腹无压痛,肝脾肋下未触及,右下腹扪及一10cm×12cm大小包块,边界尚清楚,无压痛,质中,活动度www.wjgnet.com®■背景资料克罗恩病(CD)是由BurrillCrohn在1932年最早描述的,1973年WHO将其定为Crohn病.本病以欧美国家发病率高,近几年我国发病率呈增加趋势.结核病是我国常见病之一,发病率较高,部分肠结核与CD患者临床表现、内镜及病理学改变极为相似,鉴别诊断十分困难.■同行评议者江学良,主任医师,中国人民解放...
