| 陈洋洋,吴念,黄秋锦,等.误诊为肠结核的克罗恩病 1例诊治思考[J].安徽医药,2025,29(11):2207-2211. |
| 误诊为肠结核的克罗恩病 1例诊治思考 |
| Diagnosis and treatment of Crohn's disease with misdiagnosed intestinal tuberculosis: a case report and literature review |
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| DOI：10.3969/j.issn.1009-6469.2025.11.018 |
| 中文关键词: 克罗恩病 误诊 肠结核 鉴别诊断 肠溃疡 肉芽肿 |
| 英文关键词: Crohn's disease Diagnostic errors Intestinal tuberculosis Differential diagnosis Enterelcosis Granuloma |
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| 中文摘要: |
| 目的探讨克罗恩病(Crohn's disease，CD)和肠结核的鉴别诊断，提高临床对此类疑似病例的认识。方法总结贵州医科大学附属医院分别在 2023年 4月和 6月收治的同一例误诊为肠结核的 CD病人诊治经过，并进行文献复习探讨。结果病人反复呕吐 1年余，多次就诊于当地医院及该院。腹部 CT增强检查、肠镜及镜下活检均提示回盲部结核可能。这期间行短暂抗结核药物试验性治疗，但病人症状反复并进行性加重，后于 2023年 6月行腹腔镜下右半结肠切除 +小肠部分切除 +肠吻合术，术后病人症状好转。术后病理符合 CD。随访至 2023年 8月 26日，病人病情平稳。结论临床上诊断 CD具有挑战性，特别是疑似肠结核病人，在治疗过程中发现效果欠佳时，需要警惕 CD及 CD合并肠结核的可能性。多学科协作是诊治关键，此外，运用评分系统或诊断模型或将成为未来鉴别 CD和肠结核二者极具潜力的诊断工具。 |
| 英文摘要: |
| Objective To explore the differential diagnosis of Crohn's disease (CD) and intestinal tuberculosis for better clinical un-derstanding of such suspected cases.Methods We summarized the diagnosis and treatment of the same patient with CD suspected ofintestinal tuberculosis admitted to the Affiliated Hospital of Guizhou Medical University in April and June 2023 respectively, and con-ducted a literature review.Results The patient had recurrent vomiting for more than 1 year, and visited local hospitals and our hospi-tal several times. Abdominal enhanced CT scanning and colonoscopy suggested intestinal tuberculosis. During this period, the patientwas treated with anti-tuberculosis drugs for a short time, but the patient's symptoms were repeated and progressively aggravated. Final-ly, in June 2023, the patient underwent laparoscopic right hemicolectomy, partial resection of small intestine, and intestinal anastomo-sis. After operation, the patient's symptoms improved. Postoperative pathological diagnosis was consistent with CD. We performed to-the-writing date (August 26, 2023) follow-up and found that the patient was in stable condition.Conclusions Clinically diagnosing CDis challenging, especially for patients suspected of having intestinal tuberculosis. CD or CD with intestinal tuberculosis needs to be con-sidered when poor effects are present during treatment. Multidisciplinary collaborations are key for diagnosing and treating CD. In addi-tion, the use of scoring systems or diagnostic models may become a highly potential diagnostic tool for distinguishing between CD andintestinal tuberculosis in the future. |
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