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KMID : 0371319670090070381
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Journal of the Korean Surgical Society
1967 Volume.9 No. 7 p.381 ~ p.389
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Intestinal Tuberculosis
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金春奎/Kim, Choon Kyu
金光洙/金亨潤/閔珖植/Kim, Gwang Soo/Kim, Hyung Yoon/Min, Kwang Sik
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Abstract
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The tuberculous involvement of the alimentary tract was remarkably lower in incidence and morbidity, along with pulmonary tuberculosis, since the use of antitubercular agents in 1950. However, recently it is suggested that there is an increased incidence of the gastrointestinal tuberculosis, and awarence of this is essential.
While reports relating to the diagnosis and management of the disuse have been occasionally published, it is deemed advisatle to review the problems and our experience v ith patients in Korea, where the prevalence of active pulmonary tuberculosis by human type bacilli is still high, involving 5. 1 percent of all the population over 4 years old.
These 50 cases of intestinal tuberculosis, selected according to the Bockus´ diagnostic criteria, were treated in Yonsei University Medical Center during the past 12 years from 1954 to August 1966. Of them, 28 patients had operative managements, 14 exploratory laparotomies for diagnosis, and 8 cases with gastrointestinal involvements secondary to pulmonary tuberculosis confirmed clinically and roentogenographically had conservative treatments.
The average age of all patients is 35 y_ears(44 years in males and 30 years in females), with its range from 16 to 64, and its peak incidence in the third decade. The sex ratio is approximately 1 : 2 in favcr of females, especially in the third and fourth decades.
More or less pathognomonic symptoms are so-called "Triad abdominal pain(92 percent) mostly related to postprandial discomfort, diarrhea (40 percent), and weight loss (64 percent), among protean ones with re_rassion in 56 percent. And also physical findings are not characteristic, until any complication, such as intestinal obstruction,perforation, fistula, etc., develops; however, abdominal mass is palpable in 52 percent, particularly over the right lower quadrant of the abdomen.
Pulmonary tuberculosis is not found in 22 patients on routine chest film at admission tune, and because one of them had tuberculosis elsewhere previously. so-called "primary tuberculosis of the intestine" is 42 Percent in this series. Of the patients with pulmonary tuberculosis, inactive cases are 14 percent of all cases, minimum 16 percent, moderately advanced 18 percent, and far-advanced 8 percent.
The involvement of the alimentary tract are multiple or diffuse in 88 percent of the patients, and 4 percent have ileocecal lesions. In general, the secondary type is ulcerative, usually involving the proximal tract to the ileocecal region, while the primary type is hypertrophic, involving mostly the distal part
including the ileocecal area.
It is so difficult to differentiate clinically frcm all of the atdcr ir_al diseases, especially from carchtcma and Crohn´s disease, that pathological dicgncsis should be made cn abdcminal exploration. Examination of frozen setions during operation is helpful.
Excellc_,t progncsis can to expected with primary resecticn as possible as, if the resecticn is inevitable rather than exclusion (by-pass) or diversion (exteriorizaticn) tyre of operation. It is advisable to have anti-tubercular chemotherapy post-operatively since most of the patients have multiple or diffuse type of pathology along the gastrointestinal tract.
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