以消化道穿孔伴肺部巨大空洞起病的结核感染  

Tuberculosis presenting as gastrointestinal perforation and large confluent pulmonary cavities:a case report

作　　者：范俊平[1] 朱恬缘 孙蒙清 师杰[4] 刘安雷[5] 秦岭[6] 宋兰[7] 刘雅萍[8] 田欣伦[1] 刘继海[5] Fan Junping;Zhu Tianyuan;Sun Mengqing;Sh Jie;Liu Anlei;Qin Ling;Song Lan;Liu Yaping;Tian Xinlun;Liu Jihai(Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Medical Intensive Care Unit,Peking Union Medical College Hospital,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Emergency Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Infectious Diseases,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Medical Genetics,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸与危重症医学科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院内科ICU,北京100730 [3]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院病理科,北京100730 [5]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730 [6]中国医学科学院北京协和医学院北京协和医院感染内科,北京100730 [7]中国医学科学院北京协和医学院北京协和医院放射科,北京100730 [8]中国医学科学院基础医学研究所医学遗传学系,北京100005

出　　处：《中华结核和呼吸杂志》2022年第9期904-909,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-048)。

摘　　要：本文报道1例以急性消化道穿孔起病,伴肺部巨大空洞,最终确诊为多部位结核感染的病例。患者男,23岁,主因“腹泻伴间断咳嗽、咳痰3个月,腹痛1个月,加重1 d”入急诊,CT见腹腔大量游离气体,胸部多发巨大空洞伴结节影,考虑消化道穿孔,行剖腹探查及穿孔肠段切除术。后续痰涂片回报抗酸染色阳性伴结核分枝杆菌复合群基因(Xpert)阳性,小肠病理示多量微脓肿形成,抗酸染色阳性。最终确诊为肺结核、肠结核。We report an unusual case presented as acute gastrointestinal perforation and large confluent pulmonary cavities.A 23-year-old male was admitted to the emergency department with complaints of abdominal pain for 1 month,which exacerbated for 1 day.He also reported a 3-month history of diarrhea and productive cough.Computed tomography(CT)scan showed multiple large confluent cavities in the lung,along with massive free gas in the abdomen suggesting gastrointestinal perforation.Exploratory laparotomy was performed and affected bowel segment was resected.His sputum examination was positive for both acid-fast staining and Mycobacterium tuberculosis complex gene(Xpert)testing.Pathology of small intestine revealed micro-abscess formation and was positive for acid-fast bacilli.A final diagnosis of pulmonary tuberculosis and intestinal tuberculosis was made.

关 键 词：消化道穿孔 结核感染 抗酸染色 结核分枝杆菌复合群 结节影 剖腹探查 肠结核 咳痰 

分 类 号：R57[医药卫生—消化系统] R52[医药卫生—内科学]