Korean Journal of Gastrointestinal Endoscopy 1997;17(6): 821-826.
증례 : 식도위장관 ; 십이지장 림프종과 감별이 곤란하였던 십이지장 결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Tuberculosis Which is Hardly Differentiated from Duodenal Lymphoma )
김화영, 이창후, 강정협, 한성민, 소순찬, 김종률, 김석은, 임응훈, 박석준 (Wha Young Kim, Chang Hoo Lee, Jeung Hyub Kang, Sung Min Han, Soon Chan So, Joug Yul Kim, Seok Eun Kim, Eung Whoon Imm and Suk Joon Park)
Abstract
Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures,(Korean J Gastrointest Endosc 17: 821-826, 1997)
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