A Case Report of Intestinal Tuberculosis Associated with Ileocutaneous Fistula

Tsutomu Namikawa, Seiya Nakamura, Yuji Kondo, Kuniyasu Yamashita¹⁾, Junichi Miyazaki²⁾ and Keijiro Araki³⁾

Department of Surgery¹⁾, Department pf Pathology²⁾, Kochi Prefectural Seinan Hospital
First Department of Surgery, Kochi Medical School³⁾

A case of intestinal tuberculosis associated with ileocutaneous fistula is reported. A 75-year-old man was hospitalized with complaints of fecal material discharge from a fistula in the right lateral abdomen. Mycobacterium tuberculosis was detected in his sputum as Gaffky 3, and chest plain radiography revealed an infiltrative shadow in the right upper lung field. Endoscopic examination dermonstrated circular stenosis just over the ileocecal valve, and the endoscope was not able to pass through this stenotic portion. The dilated small intestine was demonstrated to articulate with the cutaneous fistula, which was visualized by percutaneous fisterography. Under the diagnosis of intestinal tuberculosis, an operation was carried out. The ileocecal portion was found to be clumped due to inflammation, and the terminal ileum to be dilated, so right hemicolectomy was carried out. The resected specimen showed a fistula between the skin and one of the multiple intestinal ulcers. Histological examination did not reveal mycobacterium tuberculosis, but did show epitheloid granuloma accompanied with Langhans giant cell. Intestinal tuberculosis is most apt to spread superficially along the intestinal wall, and fistula formation is most uncommon. This case was intriguing, especially when contemplating the diversified conditions of intestinal tuberculosis.

Key words
intestinal tuberculosis, ileocutaneous fistula, mycobacterium tuberculosis

Reprint requests
Tsutomu Namikawa Department of Surgery, Kochi Prefectural Seinan Hospital 1973 Uyama, Nakamura-shi, 787-0015 JAPAN

Accepted
February 24, 1999

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