A CASE OF TUBERCULOSIS OF THE SMALL INTESTINE WITH REPEATED CHRONIC ILEUS SYMPTOMS WHICH PRESENTED DIFFICULTIES IN DIAGNOSIS

A case of primary tuberculosis of the jejunum which repeated chronic ileus symptoms for a long term and presented difficulties in diagnosis is described. A 64-year-old woman was seen at the hospital because of chronic abdominal distension and abdominal pain. A chest X-ray film revealed no abnormality but abdominal simple X-ray film showed a significant dilatation of the small intestine and fluid level. Barium meal method revealed a cystic and abnormally dilated lesion in a part of the small intestine. Laparotomy findings included a cystic dilated lesion in the jejunum with a narrowing in the anal side, and numerous swelling mesenteric lymph nodes. Excision of the intestine with end-to-end anastomosis was performed. Based on histopathological examination of the excised specimen, a diagnosis of tuberculosis was made. This case was not of lung tuberculosis associating with intestinal tuberculosis, but of so-called primary tuberculosis of the small intestine. It is rare to encounter such a case as presenting abnormal cystic dilatation and repeating ileus symptoms like this case. In this case an elevated serum CA-125 level was noted in the clinical course. For this, some notes are also presented here in terms of literature review.