无症状肠结核的结肠镜诊断

目的探讨无症状肠结核的结肠镜检诊断。方法回顾性分析本院1997年1月至2004年12月结肠镜检查诊断的无症状肠结核14例资料。结果结肠镜下表现:病变部位:11例位于回盲部或回肠末端,3例位于结肠;分型:炎症型3例,溃疡型4例,增殖型2例,混合型5例。病检:9例活检病理诊断肠结核,1次阳性5例,2次或以上阳性4例。结论结肠镜检重点观察肠结核好发部位及病变特征,结合活检是诊断无症状肠结核的重要手段。     

回肠末端溃疡性病变145例内镜与病理特点

目的探讨回肠末端溃疡病变的内镜与病理特点。方法回顾性分析6年来回肠末端溃疡性病变的临床、内镜及病理资料。结果 145例回肠末端溃疡性病变中男女之比为0.99∶1。内镜表现以片状溃疡为多见,病变为多发性,病理检查类型例数依次为黏膜非特异性炎症、克罗恩病、肠结核及淋巴瘤。结论回肠末端溃疡性病变临床表现无特异性,明确诊断有赖肠镜联合病理活检。     

回盲部溃疡228例的回顾性分析

目的探讨内镜及病理检查对回盲部溃疡的鉴别诊断价值.方法 收集我院2006年至2010年肠镜检查中检出的228例回盲部溃疡病例,就其临床特征、内镜及病理检查、治疗及随访情况进行总结分析,并比较克罗恩病及肠结核内镜下的形态特征.结果 (1)溃疡性结肠炎及回盲部肿瘤结合内镜及活检组织病理检查通常可明确诊断,回盲部的非特异性溃疡局部溃疡整齐或局限,多数经抗生素及培菲康等对症治疗后症状缓解,克罗恩病及肠结核只有少数通过内镜及病理活检确诊,多数经试验性治疗后随访明确诊断.(2)克罗恩病的溃疡多呈纵形或不规则形伴黏膜卵石征和肠腔狭窄,而肠结核溃疡多呈环形或环周分布伴息肉样变.结论 回盲部溃疡病变诊断主要依靠反复的病理检查及试验性治疗,尤其是肠结核和克罗恩病的诊断,因此寻找一种特异性血清或免疫组化的指标鉴别诊断回盲部溃疡是非常必要的.     

内镜及活检病理对回盲部溃疡的鉴别诊断

目的评价内镜及活检病理对回盲部溃疡性病变病因的诊断价值。方法经内镜检查发现回盲部溃疡，结合临床表现和活检病理对证实的回盲部溃疡改变如肠结核病、克罗恩病、溃疡性结肠炎、恶性淋巴瘤、大肠癌（溃疡型）进行鉴别诊断。结果内镜检查对溃疡性结肠炎、大肠癌较易诊断；对肠结核病、克罗恩病、恶性淋巴瘤诊断率不高。内镜组织活检病理形态学研究表明：异型淋巴细胞、异型上皮、类上皮结节合并干酪样坏死分别相对于恶性淋巴瘤、溃疡型大肠癌和肠结核病均有确诊意义（P〈0．05）；单纯类上皮结节（即结节样肉芽肿）见于克罗恩病和肠结核病，若未发现肠结核干酪样坏死，两者不易鉴别；隐窝脓肿多见于溃疡性结肠炎，但该病理特征诊断意义不强，可见于多种病变。结论回盲部病变以溃疡型病变最为多见。内镜及活检组织病理学检查对回首部溃疡病变的诊断是安全有效的，综合分析其结果可进一步提高诊断准确率。     

回盲部非特异性溃疡87例回顾性分析

临床上无回盲部非特异性溃疡的诊断,是一种原因不明的以回盲部局限性溃疡为特征的慢性疾病,随着近年来结肠镜及病理检查的推广应用,回盲部非特异性溃疡的检出率得到明显提高。肠镜检查时常发现有个别患者全结肠为正常内镜表现,仅在末端回肠或回盲瓣存在局限性溃疡,从外观看溃疡小,形态较规则,周边黏膜正常或充血水肿,病变肠段蠕动良好,触之质软,镜下为良性溃疡改变,     

19例胃肠结核的影像学分析

目的 探索胃肠结核的影像学特点。方法回顾分析经确诊为胃肠结核19例病例,从病灶部位、形态、边缘、周围组织的影像改变进行分析。结果19例患者中,胃窦部结核1例,空肠结核1例,末端回肠、回盲部结核15例,回盲部及升结肠同时受累1例,横结肠结核1例。本组病例影像诊断,除胃结核、回盲部结核各1例误诊外,其余均与病理诊断相符合,误诊率为10.5%,准确率89.5%。结论胃肠结核的影像表现有一定的特征性,但必须结合临床病史,进行病理、细菌学检查才可做出明确的诊断。     

异基因造血干细胞移植后肠道病变的内镜表现

目的探讨结肠镜检查在诊断异基因造血干细胞移植（allo-HSCT）后肠道移植物抗宿主病（GI-GVHD）和巨细胞病毒（CMV）肠炎中的作用。方法回顾性对比分析GI-GVHD、CMV肠炎以及GI-GVHD合并CMV肠炎（GC）的结肠镜检查表现及其相关问题。结果47例患者接受50例次结肠镜检查，其中GI-GVHD32例次，CMV肠炎7例次，GC11例次，他们的一般临床资料具有可比性（P〉0．1）；GI-GVHD、CMV肠炎和GC外周血CMV-DNA阳性率分别为28．1％、42．9％和27．3％，三组间差异没有统计学意义（P〉0．1）；肠镜下GI-GVHD和CMV肠炎都有结肠黏膜病变，病变表现呈多样性，除黏膜龟纹样改变和深在溃疡分别是GI-GVHD和CMV肠炎较为特异的病变外，黏膜水肿、红斑、充血、糜烂及浅表溃疡均不能区分GI-GVHD和CMV肠炎；3例GI-GVHD有伪膜形成，1例CMV肠炎有疱疹样黏膜隆起，GC患者容易发生回肠黏膜活动性渗血和回盲瓣炎症。GI-GVHD、CMV肠炎和GC分别有63．8％、70．0％和43．8％的活检标本取自直乙状结肠。结论allo-HSCT患者外周血CMV—DNA检查难以区分GI—GVHD和CMV肠炎；黏膜龟纹样改变和深在溃疡分别是GI-GVHD和CMV肠炎较为特异的改变；GC患者更容易发生回肠黏膜渗血和回盲瓣炎症。左半结肠检查及组织活检能诊断大部分GVHD和CMV感染，但最好进行全结肠检查并到达回肠末端。     

肠结核的临床影像诊断及与克罗恩病的鉴别诊断

结核病在全世界仍处在一个较高发病区间,是全世界的重大公共卫生问题。中国是占全球结核病总数2/3的8个国家中的一员,结核病防控形势依然严峻。肠结核多继发于肺结核,是腹部结核中最常见的一种,肠结核85%～90%位于回盲部,即位于回盲瓣及其相邻的回肠和结肠,其他发病部位依次为升结肠、空肠、横结肠等。肠结核一般起病缓慢,可表现为腹痛、腹部包块、腹泻与便秘等。影像学检查对肠结核诊断具有重要意义,尤其是腹部CT检查对了解肠道病变的内部结构、肠壁的浸润程度等均有较大价值;X线气钡双对比造影、PET/CT检查有一定的诊断意义,但临床上较少应用。腹部CT平扫,肠结核多表现为肠壁环形增厚、肠腔狭窄,可呈肠道跳跃性改变;CT增强扫描见病变段肠壁明显呈均匀强化,且有分层现象,表现为“靶征”和“双环征”。克罗恩病是一种原因不明的肠道炎症性疾病,亦好发于回肠及右半结肠,病变呈节段性、跳跃性改变。影像学和纤维肠镜检查发现,克罗恩病与肠结核两者黏膜溃疡不同,克罗恩病为多发纵横交错的线形溃疡,以纵行溃疡为特点,肠结核则以横行的、全周性的带状溃疡和星状溃疡为特点。克罗恩病与肠结核鉴别困难时需依靠病理检查,克罗恩病组织病理...     

肠型白塞氏病4例

目的总结寻找肠型BD的临床及X线特征．方法4例BD，男3例，女1例，都经过病理组织学证实，每个患者都具有两个以上BD的基本临床表现及伴有其他一些特殊症状，均在基本临床症状出现后3a～4a才出现反复发作的消化道症状，即腹痛、腹泻、便血等．均同时做过1次以上的钡餐或钡灌肠检查及肠镜检查，病变均仅见于回盲部及末端回砀，表现为1．5cm以上较大而深的溃疡，1例大溃疡周围有多个小溃疡及小充盈缺损，1例末端回肠有5cm长狭窄及小充盈缺损.结果通过本组病例及文献复习看出肠型BD是指以肠道症状为主要表现的BD，多在发病后数年开始出现肠道表现，回盲部及末端回肠是主要发病部位，病理特征是肠壁的慢性非特异性炎症及小血管炎．X线表现理论上分为溃疡型和增殖型，但其最常见是较大而深的溃疡，或并发周围之小溃疡或小充盈缺损或肠管狭窄，单纯增殖型很少见，病变多反复发作，此消彼长．鉴别诊断主要是与克隆氏病、溃疡性结肠炎及回盲部结核区别．结论肠型BD好发于回盲部及末端回肠，以反复发作的大溃疡或其周围伴有多个小溃疡或小充盈缺损为特征．     

回肠末端溃疡性病变临床特点分析

回肠末端指回盲瓣至回肠肛侧约30 cm的部分,它是小肠病变多发部位,随着结肠镜插镜技术的提高以及双气囊小肠镜的应用,其病变检出率不断提高.发生在回肠末端的溃疡性病变,如克罗恩病、肠结核、淋巴瘤等,其内镜下表现及临床特点相似,容易误诊.本文对55例回肠末端溃疡患者的临床特点、内镜下表现及诊治情况进行总结分析.     

Ileoscopy in patients with ileocolonic tuberculosis

AIM: To study the role of retrograde terminal ileoscopy in patients suspected to have ileocolonic tuberculosis. METHODS: A retrospective analysis was performed for patients undergoing colonoscopy for suspected ileocolonic tuberculosis between January 2000 and June 2004, in whom retrograde ileoscopy had been performed. Only patients diagnosed with tuberculosis on the basis of histological findings of either a caseating granuloma or those having non-caseating granuloma or a collection of epithelioid cells at a minimum of one endoscopic lesion (either in the colon or the terminal ileum) on histology with good responses to conventional anti-tuberculous drugs were enrolled for the study. RESULTS: Fifty-three patients were included. The terminal ileum was involved in only 11 patients. Eight of these patients had involvement of the cecum too. Two patients had ileal lesions without cecal involvement; however, lesions were noted in the ascending colon. In one patient the whole colon was normal and only the terminal ileum showed nodularity and ulceration. Histological examination of the ileal biopsies obtained from the ileal lesions showed noncaseating granulomas in five, collection of epithelioid cells in four and nonspecific histology in two patients. Mucosal biopsies obtained from the lesion in the terminal ileum, in the patient in whom mucosal abnormality was observed to be confined to the ileum, showed noncaseating granulomas. In two other patients the ileal biopsies alone showed histological evidence of tuberculosis with biopsies from the colonic lesions showing non-specific inflammatory changes only. CONCLUSION: Retrograde ileoscopy should be performed in all patients undergoing colonoscopy for suspected ileocolonic tuberculosis. In some patients only the terminal ileum may be involved and histological examination may reveal evidence of tuberculosis only from the lesions in the terminal ileum. This approach would lead to additional lesions being picked up andincreasing the chances of well-timed diagnosis of tuberculosis.     

Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients

BACKGROUND: Colonoscopy with terminal ileoscopy is crucial for the diagnosis of intestinal tuberculosis. This report describes characteristic endoscopic findings in patients with intestinal tuberculosis with few or no clinical symptoms. METHODS: Data for 11 consecutive patients in whom a diagnosis of intestinal tuberculosis was made during the last 15 years in one facility were reviewed. Clinical findings and the frequency of endoscopic findings were evaluated. Mucosal lesions were classified into 4 types: type 1, circumferential ulceration with nodules; type 2, round or irregularly shaped small ulcers, arranged circumferentially, without nodules; type 3, multiple erosions restricted to the large intestine; and type 4, small ulcers or erosions restricted to the ileum. The gross endoscopic appearance of healed lesions included patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal areas with aggregated ulcer scars. RESULTS: Only one patient had remarkable clinical symptoms (anorexia and weight loss), whereas, the other 10 had few or no symptoms. The frequency of type 1, 2, 3, and 4 endoscopic findings was, respectively, 36%, 36%, 9%, and 18%. The frequencies for patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal area were, respectively, 45%, 45%, and 91%. CONCLUSIONS: When colonoscopy is performed in asymptomatic patients, it is important to be aware of subtle endoscopic findings that are characteristic for intestinal tuberculosis. Recognition of such findings may lead to a correct diagnosis of early stage intestinal tuberculosis.     

Radiological demonstration of colonic aphthoid ulcers in a patient with intestinal tuberculosis

The case is described of a young Asian woman with massive rectal haemorrhage during and after pregnancy. Barium radiology showed aphthoid ulcers in the colon and changes in the ileum suggesting tuberculosis. Colonoscopy revealed hyperplastic ulceration in the terminal ileum and culture of biopsies from this area grew Mycobacterium tuberculosis. The patient made a full and rapid recovery on anti-tuberculous therapy. Colonic aphthoid ulceration has not previously been recorded, radiologically, in intestinal tuberculosis.     

Tuberculous colitis mimicking Crohn's disease

Intestinal tuberculosis is a rare disease in western countries and may mimic a variety of gastrointestinal disorders. Here, we report the case of a 63-yr-old patient who presented with profuse bleeding from a deep rectal ulcer. Similar lesions were found in different parts of the colon. Multilocular colorectal carcinoma was suspected based on the macroscopic appearance. Histology, however, suggested Crohn's disease. Intestinal tuberculosis was initially ruled out by negative staining for acid-fast bacilli, mycobacterial culture, and polymerase chain reaction analysis. A treatment for Crohn's disease was started. Endoscopic reexamination revealed progressive disease with extensive ulcerations of the terminal ileum. Histopathological examination then revealed acid-fast bacilli in the colonic mucosa typical for mycobacterium tuberculosis infection. This case emphasizes the need to include intestinal tuberculosis in the initial differential diagnosis of ulcerative colorectal lesions also in the western population.     

Multiple adenocarcinomas and premalignant changes in "backwash" ileitis.

In a patient with long-staning ulcerative colitis and "backwash" ileitis, multiple carcinomas developed in the colon and ileum. In both locations premalignant mucosal changes of the basal cell proliferation type were seen adjacent to and remote from sites of carcinoma. Although the frequency of such premalignant and malignant changes in "backwash" ileitis is unknown, their concurrence in this case suggests that ulcerative colitis involving the terminal ileum increases the risk of small bowel carcinoma.     

A Case of Extensive Gastrointestinal Involvement of Malignant Lymphoma Associated with Early Gastric Carcinoma

Abstract: Described is a 59 year old Japanese man With malignant lymphoma involving the stomach, duodenum, terminal ileum, colon and rectum, who developed early gastric carcinoma. Repeated gastroduodenoscopy revealed various appearances of the gastrointestinal involvement in malignant lymphoma, such as giant folds, polypoid lesions, and ulcerations, in addition to a depressed lesion of early gastric carcinoma. Colonoscopy also showed multiple polypoid lesions throughout the large bowel. Though the gastrointestinal involvement in malignant lymphoma is not rare, diffuse multiple polypoid lesions in the entire large bowel as seen in our case have rarely been endoscopically described. The coexistance of malignant lymphoma and gastric carcinoma in our case might be only a coincidence, though some reports of an increasing incidence of second tumors in patients with malignant lymphoma have been published. Further consideration will be needed as to the relationship between malignant lymphoma and the occurence of a second malignancy.     

Colonoscopic study of 50 patients with colonic tuberculosis.

Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%). A nodular mucosa with areas of ulceration was the usual colonoscopic finding. Ileocaecal disease was found in 16, ileocaecal and contiguous ascending colon disease in 14, segmental colonic tuberculosis in 13, ileocaecal disease and non-confluent involvement of another part of the colon in five, and pancolitis in two patients. This report emphasises that colonoscopy is a useful procedure for diagnosing colonic tuberculosis and that segmental colonic tuberculosis is not uncommon.     

Chediak-Higashi syndrome with intestinal complication. Report of a case

A 21-year-old woman with Chediak-Higashi syndrome developed intestinal lesions similar to those of Crohn's disease. Radiographic findings showed a stenotic lesion with multiple nodular changes in the ascending colon and cecum, and a longitudinal ulceration in the terminal ileum. In addition, multiple oval-shaped ulcerations were seen between the terminal ileum and descending colon. However, serial histological examinations revealed only an infiltration of lymphoid cells, which was a nonspecific finding. Though there are few reports of gastrointestinal involvement in Chediak-Higashi syndrome, such an intestinal complication may develop in patients long surviving with this disease.     

Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor

Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis. A solitary Peutz-Jeghers type polyp of the stomach is rare. We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months. During the hospital treatment course for this patient, endoscopic examination revealed a bulging lesion with a central hole, mucosal ulceration, an asymmetrical wall thickness and a narrowing of the gastric lumen. A gastric biopsy further revealed ulceration with moderate dysplasia. The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm × 3 cm. Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes, all greater than 1 cm. The suspected diagnosis was malignant gastric cancer with lymph node metastases. The other lesion, which measured 2 cm × 2 cm × 1 cm was noted in the submucosa of the jejunum during surgery. The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor. The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer, and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum. This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.