복강내 결핵의 임상적 고찰

Background/Aims: In Korea, intra-abdominal tuberculosis is decreasing, but:,till a common cura- ble disease by antituberculous medication and has potency of rebounding prevalence rate due to steadily increasing acquired immunodeficiency syndrome(AIDS). Due to the above reasons and easy accessibility of colonoscopy and laparoscopy, importance of histologic and microbiologic dia- gnosis should be more emphasized. We have conducted this study to observe the clinical charac- teristics and cere reviewing the literature for better and improved management in this clinical field. Methods: We retrospectively observed 65 patients who had been dignosed with intra- abdominal tuberculosis histologically or microbiologically at Kangbuk Samsung Hospital frorn 1980 to 1996. Results: The most cornmon site of the disease involvement was the terminal ileum(40.0%). 60.0% of the patients were between the ages from 20 and 4C. The ratio of male to female was 1:1.2. Clinical symptoms were abdominal pain, diarrhea, general weakness, etc. and the physical signs were abdominal tenderness, abdominal distention, abdominal mass, etc. There was an evidence of pulmonary tuberculosis including pleural effusion and iliary tuberculosis in 70.8% of the patients and cervical tuberculous lymphadenitis in 3.1%. Modalities for definite diagnosis were colonoscopy in 56.9% of the patients, laparoscopy in 26.2% and explo-laparotomy in 16.9%. Results of AFB smear and biopsy showed caseous necrosis in 52 3% of the patients, positive AFB in 31.3% and both in 15.4%. Methods for treatent were antituterculous medication in 84.5% of the patients, surgical resection with antituberculous medication in 9.2% and conservative treatment in 6.2%. Clinical improvement was observed in 96.9% of the patients while 2 of the patients(3.1%) died. Conclusions: As intra-abdominal tuberculosis rnay show indefinite and nonspecific clinical and physical findings, it might be difficult to confirm diagnosis by blood, ascites and imaging studies. Therefore, if suspected, we suggest that histologic and microbiologic approach employing colonoscopy or laparoscopy is in essential step in diagnosing intra-abdominal tuberculosis. (Korean J Gastroenterol 1997; 30:749-758)