구불결장의 동일 부위에 발생한 선암과 결핵성 림프절염 1예

류성호,신운건,박소연,김성준,조성진,김학양,이승민,유종진 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.5

Inflammatory bowel disease can progress to colon cancer. However, there is not much of a causal relationship between intestinal tuberculosis and colon cancer. There have been a few case reports of intestinal tuberculosis in association with colon cancer. We experienced a 59-year-old man who had the collision-like pathology of adenocarcinoma and tuberculous lymphadenitis on the sigmoid colon. He visitied our hospital because of abdominal pain and hematochezia. Colonoscopy showed a mass on the sigmoid colon that was causing luminal obstruction. Therefore, sigmoidectomy was performed and the resected specimen revealed a collision-like appearance; the mass was composed of adenocarcinoma invading the proper muscle layer and caseating granuloma in the serosa and lymph nodes. We report here on a case of collision-like pathology that was composed of adenocarcinoma and tuberculosis on the sigmoid colon, and we review the relevant literature. 선암종에는 그 전암성 병변인 선종이 혼재하는 경우가 흔한데 염증성 병변인 건락성 육아종 위에 선암종이 경계를 분명히 하며 얹혀 있는 형태의 충돌 병변은 매우 흥미로운 경우로, 결핵과 대장암의 공존의 기존 보고는 대장결핵의 호발 부위인 회맹부, 상행결장에 우세하게 발견되었으나 대장암의 호발 부위인 구불 결장에 충돌 병변 모양으로 보고된 예는 아직까지 없었다. 본 증례는 좌하복부 동통, 복부 팽만감, 체중 감소를 보이던 남자에서 구불결장의 동일한 위치에 대장암과 결핵병소가 경계를 분명히 하면서 충돌 형태로 나타나 수술 후 항결핵제 투여하여 치료한 예를 경험하여 보고한다.

Nodo-Colonic Fistula Caused by Intra-Abdominal Tuberculous Lymphadenitis during Treatment with Anti-Tuberculous Medication: A Case Report

남경선,배경은,정명자,이지혜,강미진,김재형,김수현 대한영상의학회 2016 대한영상의학회지 Vol.75 No.2

Recently, the overall incidence of tuberculosis has decreased, but the incidence of an extrapulmonary manifestation in patients with tuberculosis has increased in the Republic of Korea. Although intestinal tuberculosis is not infrequent, a fistula caused by tuberculosis is a rare condition. A 23-year-old man presented with fever, diarrhea and right lower quadrant pain. A computed tomography (CT) scan revealed a lobulated, peripherally enhancing, low density mass in the mesentery. The patient underwent laparoscopic biopsy for necrotic lymph node, and intra-abdominal tuberculous lymphadenitis was diagnosed. Four months after initiating treatment with anti-tuberculous medication, the patient developed fever together with lower abdominal pain. A follow-up CT scan revealed a fistulous tract that had developed between the initially noted lymphadenopathy and the proximal ascending colon. Laparoscopic right hemicolectomy was performed as a curative treatment. This case suggests that a nodo-colonic fistula may occur as a paradoxical response in patients with intra-abdominal tuberculous lymphadenitis during treatment with anti-tuberculous medication.

대장암으로 오인된 장결핵 3례

문봄내,박찬호,한상훤,김철홍,김경욱,최선희,윤중근,설상영 인제대학교 백병원 2003 仁濟醫學 Vol.24 No.1

A lesion which is visualized on colonoscopic examination is rather confusing in that one will find a ulcerative tumor mass occupying the lumen of the bowel which is most suggestive of carcinoma. Especially, tuberculosis of the distal colon occurring in the absence of pulmonary involvement is often mistaken for neoplasm or Crohn's disease. We experienced three cases of colon tuberculosis mimicking a ulcerative tumor mass occupying the lumen of the colon.

진단이 지연된 결장 결핵에 의한 난치성 요근 농양 - 증례 보고 -

이재영,정승재,김윤수 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.4

Study Design: A case report. Objectives: To report a rare case of intractable psoas abscess due to delayed diagnosis of colon tuberculosis. Summary of Literature Review: Most psoas abscesses occur primarily or secondarily due to infection of the vertebral body or discs; however, in rare cases, the etiology is not musculoskeletal in nature. In such cases, since diagnosis and treatment of the causal factor can be delayed, the psoas abscess may recur multiple times and eventually become difficult to treat. Materials and Methods: An 18-year-old female patient visited our institution complaining of right lower quadrant abdominal pain and right hip pain. On abdominal computed tomography (CT), a psoas abscess was observed and colon tuberculosis was suspected. She was treated with a ultrasonographically guided percutaneous drainage procedure. Considering the possibility of colon tuberculosis and related fistulae, a barium enema was performed; nonetheless, no fistula was found. After 2 months, the psoas abscess recurred, and thus incision and drainage were performed. Symptoms redeveloped 4 months after the incision and drainage; the patient was further evaluated with magnetic resonance imaging and recurrence of psoas abscess was again observed; incision and drainage were performed once again. A gross draining sinus developed on the right lower abdomen 11 months after the last procedure. On barium enema and abdominal CT scan, an enterocutaneous draining sinus was spotted at the right ascending colon, and right hemicolectomy was thus performed. Results: The psoas abscess did not recur during an 8-year follow-up period after right hemicolectomy. Conclusions: In treatment of secondary psoas abscess, diagnosis and treatment of the etiology is crucial. 연구계획: 증례 보고. 목적: 진단이 지연된 결장 결핵에 의한 난치성 요근 농양에 대하여 보고한다. 선행문헌의 요약: 요근 농양은 원발성으로 발생하거나 척추체 또는 추간판의 감염에 의해 이차적으로 발생하는 경우가 대부분이나, 드물게 근골격계 외의 원인에 의해 요근 농양이 발생할 수 있다. 이러한 경우 원인 질환의 진단 및 치료가 지연되면 요근 농양이 수 차례 재발할 수 있으며 치료가 어려울 수있다. 대상 및 방법: 18세 여자 환자가 우 하복부 동통 및 우 고관절부 동통을 주소로 내원하였다. 복부 CT 상 요근 농양이 발견되었고 결장 결핵이 의심되었다. 요근 농양에 대하여 초음파 유도하 경피적 배농술을 시행하였다. 결장 결핵 및 이로 인한 장루에 의해 요근 농양이 발생하였을 가능성이 있어 바륨 관장을 시행하였으나 장루는 관찰되지 않았다. 2개월 후 요근 농양의 재발 소견을 보여 절개 배농술을 시행하였다. 이후 4개월 뒤 증상이 재발하여 자기공명영상을 시행하였고 요근 농양의 재발 소견이 관찰되어 절개 배농술을 다시 시행하였다. 11개월 후에 우 하복부에 배농 동이 발생하였고 바륨 관장 및 복부 CT 상 우측 결장에서 장피부누공이 관찰되어 우측 결장반절제술을 시행하였다. 결과: 우측 결장반절제술 후 8년 추시 간 요근 농양은 재발하지 않았다. 결론: 이차성 요근 농양의 치료에서 원인 질환의 진단 및 치료가 매우 중요하다.

장천공을 유발한 대장결핵이 동반된 대장암 1예

김치훈,한혜승,김정환,김병국,장성환 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.5

Tuberculosis can involve any part of the body and there are case reports of tuberculosis coexisting with malignancy in most body organs. However, cases of intestinal tuberculosis associated with colon cancer have rarely reported. Inflammatory bowel diseases can progress to malignant diseases due to mucosal dysplastic change. Similarly, intestinal tuberculosis can cause chronic inflammation, but the exact relationship between intestinal tuberculosis and colon cancer is currently obscure. A 71-year-old woman visited our hospital because of abrupt right lower abdominal pain that progressed to rebound tenderness and abdominal rigidity. Abdominal computed tomography showed a polypoid mass in the cecum and a distended terminal ileum. Right hemicolectomy was performed and the surgical specimen revealed extremely well differentiated adenocarcinoma combined with intestinal tuberculosis and bowel perforation in the cecum. We report here on a rare case of colon cancer coexisting with colonic tuberculosis and this presented as bowel perforation. We also include a review of the relevant literature. 결핵은 인체의 어느 부위에서나 감염을 일으킬 수 있으며 대부분의 장기에서 악성종양과 합병되는 경우가 보고되지만 대장에서 두 질환이 합병되는 경우는 드물며, 더욱이 장천공이 동반되고 병리 소견에서 최대 고분화 선암을 보인 경우는 보고된 바 없다. 염증성 장질환은 만성 염증을 일으켜서 점막의 이형성 변화를 일으킬 수 있는 전암성 병변이지만 이와 비슷한 양상으로 만성 염증을 일으킬 수 있는 장결핵의 경우에는 아직 대장암과의 인과관계에 대한 기전이 확립되어 있지 않다. 최대 고분화 선암은 정상적인 선과 흡사한 형태를 지닌 분화가 좋은 선암으로 세포들은 풍부한 세포질과 일정한 핵을 지닌다. 저자들은 우하복부 통증을 주소로 내원하여 시행한 복부 컴퓨터단층촬영에서 맹장 부위에 대장암이 의심되고 장천공을 시사하는 임상 소견이 있어서 우반 결장절제술을 시행 받은 환자에서 병변에 장천공이 관찰되고 조직검사에서 장결핵과 최대 고분화 선암이 동반된 1예를 경험하여 문헌고찰과 함께 보고한다.

A Case of Sigmoid Colon Tuberculosis Mimicking Colon Cancer

유성민,Jong-Hwan Park,Min-Dae Kim,Hee-Ryong Lee,Peel Jung,Tae-Hyun Ryu,Seung-Ho Choi,Il-Seon Lee 대한대장항문학회 2012 Annals of Coloproctolgy Vol.28 No.5

Tuberculosis of the sigmoid colon is a rare disorder. An 80-year-old man visited Bongseng Memorial Hospital for medical examination. A colonoscopy was performed, and a lesion in the sigmoid colon that was suspected to be colon cancer was found. A biopsy was performed, and tuberculous enteritis with chronic granulomatous inflammation was diagnosed. Intestinal tuberculosis is most frequent in the ileocecal area, followed by the ascending colon, transverse colon, duodenum,stomach, and sigmoid colon, in descending order. Hence, we report a case of intestinal tuberculosis in the sigmoid colon,which is rare and almost indistinguishable from colon cancer.

증례 : 위와 대장을 동시에 침범한 장결핵

김주형 ( Joo Hyoung Kim ),전용철 ( Yong Cheol Jeon ),김태엽 ( Tae Yeob Kim ),은창수 ( Chang Soo Eun ),손주현 ( Joo Hyun Sohn ),한동수 ( Dong Soo Han ),장재정 ( Jae Jung Jang ),박용욱 ( Yong Wook Park ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.5

Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis and should be differentiated from the inflammatory bowel diseases and malignancy such as Crohn`s disease, ulcerative colitis, amebic colitis, and colon cancer. Most frequently involved sites (75% of cases) are the terminal ileum and cecum. Other sites of involvement, in order of frequency, are ascending colon, jejunum, appendix, duodenum, stomach, esophagus, sigmoid colon, and rectum. Intestinal tuberculosis simultaneously involving the stomach and colon has been very rarely reported. Recently, we experienced a case of synchronous gastric and colonic ulcers with granulomatous inflammation. Although we did not find acid fast bacilli and the culture test was negative, empirical anti-tuberculosis therapy resulted in dramatic clinical and endoscopic improvement. We report a rare case of multifocal gastrointestinal tuberculosis with a review of literature. (Korean J Gastroenterol 2008;52:320-324)

Tuberculosis of Ascending Colon with Submucosal Abscess

Ham, Hee Won 건국대학교 의과학연구소 1992 건국의과학학술지 Vol.2 No.-

1940년대 이후 항결핵제의 발달로 인하여 폐결핵은 물론이고 소화관의 장결핵도 그 발병빈도가 급격히 감소되었다. 장결핵은 대부분 말단 회장 및 회맹부 접합부위에 많이 발병하며 회맹부의 하부 결장, 충수 그리고 공장에서 발병하기도 한다. 그러나 회맹부 하부 결장에만 국한되어 있는 경우에는 그 발병 빈도가 매두 낮고 또한 병변이 양성 및 악성 종양과 구별하기 매우 어려워 수술후 진단이 내려지기도 한다. 본 저자는 단지 혈변만이 주소인 상행 결장에만 국한된 결핵으로서 방사선 소견상 상행 결장에 점막하 낭성 종괴를 보여 괴사성 암종과의 술전 감별진단이 어려웠던 경우를 치험하였기에 병리학적 소견 및 문헌고찰과 함께 보고하는 바이다. The tuberculous involvement of the alimentary tract was abruptly decreased in incidence and morbidity along with pulmonary tuberculosis since the advent of effective antituberculous chemotherapy ti the 1940s. Tuberculosis of the gastrointestinal tract most commonly involves the ileocecal region. The colon distal to the ileocecal area, appendix and jejunum are other rare sites of involvment. Especially, localized segmental involvement of the colon distal to the ileocecal region is very rare and difficult to differente from benign or malignant neoplasm. The diagnosis of this case is tuberculosis localized in the ascending colon and is difficult to differentiate from necrotic submucosal tumor of the colon due to submucosal cystic mass in radiologic examination. Pathologic correlation and a review of the literature are provided.

십이지장과 대장을 동시에 침범한 결핵 1예

이만재,박치영,곽재정,유보열,기장도,박찬국,김만우,김정용 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

Tuberculosis of duodenum is so rare and is usually secondary to pulmonary or intestinal tuberculosis . It is difficult to diagnose duodenal tuberculosis in clinical and radiologic findings due to its non-specific symptoms and inconsistent lesion. The diagnosis was made on the basis of the histological study of the endoscopic biopsy and resected surgical specimen. so we report a case of tuberculosis of duodenal bulb and of ascending colon with, the brief review of the literatures.

조기 대장암의 근치 절제술 후 폐전이로 오인된 폐결핵 1예

김창준 ( Chang Joon Kim ),박동일 ( Dong Il Park ),박성근 ( Sung Keun Park ),박정호 ( Jung Ho Park ),손정일 ( Chong Il Sohn ),전우규 ( Woo Kyu Jeon ),김영호 ( Young Ho Kim ),이선영 ( Sun Young Lee ) 대한장연구학회 2007 Intestinal Research Vol.5 No.2

Early colon cancer can be cured by endoscopic mucosal resection (EMR). However, the possibility of complete resection depends on the depth of cancer invasion. Ten percent of cancers invading the submucosal layer are associated with local lymph node metastasis. Therefore, colon cancers confirmed to invade the submucosal layer after EMR require surgical resection. We treated a woman with adenocarcinoma at the hepatic flexure with submucosal invasion diagnosed after piecemeal EMR. Subsequent right hemicolectomy with lymph node dissection revealed no residual cancer. However, after 21 months, multiple pulmonary nodules were incorrectly diagnosed as pulmonary metastases, based on the radiological findings. The final diagnosis of pulmonary tuberculosis was made after lung metastasectomy. (Intest Res 2007;5:196-199)