Korean Journal of Gastrointestinal Endoscopy 2008;37(6): 433-437.
복강내 결핵성 림프절염에서 항결핵제 치료중 발생한십이지장 누공 1예
이경록ㆍ서강석ㆍ조준호ㆍ최상철ㆍ김강ㆍ임연근ㆍ홍건영ㆍ박상욱
광주기독병원 내과
A Case of Duodenal Fistula Caused by Intra-abdominal Tuberculous Lymphadenopathy during Anti-tuberculous Medication
Kyong Rok Lee, M.D., Kang Seok Seo, M.D., Jun Ho Cheo, M.D., Sang Cheol Choi, M.D., Kang Kim, M.D., Youn Gun Yim, M.D., Gun Young Hong, M.D. and Sang Wook Park, M.D.
Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
Abstract
Recently, the proportion of extrapulmonary tuberculosis in patients has increased in Korea. Though intestinal tuberculosis in not infrequent, a duodenal fistula caused by tuberculosis is a rare condition. A 29-year-old man was admitted to the Department of Internal Medicine because of fever and weight loss. The patient was a doctor participating in a resident fellowship. The patient was diagnosed with intra-abdominal tuberculous lymphadenopathy and was given anti-tuberculous medication. One month after the administration of medication, the patient showed symptoms and signs of duodenal obstruction because of marked duodenal wall edema and a deep ulcer on the second portion of the duodenum. A computerized tomogram and duodenography revealed the formation of a fistula at the second portion of the duodenum and the presence of abscess-forming tuberculous lymphadenopathy. The use of continuous anti- tuberculous medication resulted in the improvement of the clinical symptoms, with complete healing of the duodenal fistula and tuberculous lymphadenitis. This case suggests that transient clinical worsening in intra-abdominal tuberculous lymphadenitis may occur during an early period of anti- tuberculous medication. (Korean J Gastrointest Endosc 2008;37:433-437)
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