회장말단의 결핵 반흔에 의한 가성 게실의 급성출혈 1예 = Acute Pseudodiverticular Bleeding from a Tuberculous Scar of the Terminal Ileum

다국어 초록 (Multilingual Abstract)

Acquired ileal diverticuli are an uncommon condition and the diagnosis is often difficult when bleeding occurs from this source. Tuberculosis mainly involves the terminal ileum and has associated complications such as obstruction, perforation, stricture and bleeding, but rarely presents with pseudodiverticuli with a fistula. A 42-year-old man presented with massive hematochezia for three days. The patient had a history of pulmonary tuberculosis with complete recovery two times. Emergency sigmoidoscopy, esophagoduodenoscopy and computed tomography of the abdomen could not detect the bleeding focus. The next day, colonoscopy was performed, which demonstrated the opening of pseudodiverticuli at the terminal ileum. There was an exposed vessel in one of the pseudodiverticuli. The patient was treated successfully with epinephrine and ethanol sclerotherapy. A subsequent colonoscopy showed that the exposed vessel was completely healed seven days later. We report a case of acute pseudodiverticular bleeding from a tuberculous scar of the terminal ileum with a review of the relevant literature.

국문 초록 (Abstract)

후천성 회장 게실의 출혈은 흔하지 않은 질병으로, 장염, 결핵, 크론병, 궤양성 대장염, 림프종, 거대세포바이러스 감염 등에 의해 드물게 회장 말단에 가성 게실과 누공을 형성할 수 있다. 42세 남자가 다량의 혈변을 주소로 내원하였다. 과거력에서 30년 전과 10년 전에 폐결핵으로 치료 받았고, 20년간 매일 소주 1병을 마시는 음주력이 있었다. 내원 당일 위내시경, S상결장경, 복부전산화 단층촬영을 시행했으나 출혈부위를 찾지 못하였고 다량 혈변이 지속되어 대장정결 후 대장내시경을 다시 시행하였고, 회장 말단에 결핵 반흔으로 보이는 가성 게실이 관찰되었다. 게실 내부에 노출된 혈관에서 활동성 출혈이 있었고 에피네프린과 에탄올로 경화술을 시행하였다. 저자들은 대장내시경을 통해 회장 말단부위에 결핵 반흔에 의한 가성 게실을 확인하고, 게실 내에 활동성 출혈을 보이는 혈관의 노출을 발견하여 내시경적으로 치료한 1예를 문헌고찰과 함께 보고한다.

참고문헌 (Reference)

1 Sherman S, "Tuberculous enteritis and peritonitis report of 36 general hospital cases" 140 : 506-508, 1980

2 Akinoǧlu A, "Tuberculous enteritis and peritonitis" 31 : 55-58, 1988

3 Paustian FF, "Tuberculosis of the intestine. in: Gastroenterology, vol.11. 2nd ed" W.B. Saunders Co 311-, 1964

4 Marshall JB, "Tuberculosis of the gastrointestinal tract and peritoneum" 88 : 989-999, 1993

5 Chen WS, "Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis" 35 : 189-192, 1992

6 Murata A, "Successful endoscopic hemostasis for bleeding from an acquired ileal diverticulum" 99 : 42-45, 2008

7 Bhargava DK, "Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy" 87 : 109-112, 1992

8 Tandon HD, "Pathology of intestinal tuberculosis and its distinction from Crohn’s disease" 13 : 260-269, 1972

9 Schulze K, "Intestinal tuberculosis: experience at a Canadian teaching institution" 63 : 735-745, 1977

10 Friedenberg KA, "Intestinal perforation due to Mycobacterium tuberculosis in HIV-infected individuals: report of two cases" 88 : 604-607, 1993

11 Senise JF, "Ileal loop perforation caused by tuberculosis in patients with the acquired immunodeficiency syndrome" 109 : 61-64, 1991

12 Grobmyer SR, "Ileal diverticulitis: clinical and radiographic presentation" 49 : 498-502, 2004

13 Kita H, "Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease" 20 : 179-194, 2006

14 Kouraklis G, "Diverticular disease of the small bowel: report of 27 cases" 86 : 235-239, 2001

15 Yang SK, "Colonoscopic Diagnosis. 1st ed" Kun ja 1999

16 Matsumoto A, "Acquired ileal diverticulum: an unusual bleeding source" 35 : 163-167, 2000

17 Kapoor VK, "Abdominal tuberculosis: the Indian contribution" 17 : 141-147, 1998

18 Bhansali SK, "Abdominal tuberculosis. Experiences with 300 cases" 67 : 324-337, 1977