A case of mesenteric lymph node tuberculosis diagnosed by single-port laparoscopic biopsy

TAKAI Akihiro, KUSHIHATA Fumiki, TOHYAMA Taiji, TAKEBAYASHI Takaaki, TAKADA Yasutsugu

doi:10.3919/jjsa.74.952

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Other Title

単孔式腹腔鏡下生検を行った腸間膜リンパ節結核の1例
症例単孔式腹腔鏡下生検を行った腸間膜リンパ節結核の1例
ショウレイタンコウシキフククウキョウカセイケンオオコナッタチョウカンマクリンパセツケッカクノ 1レイ

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Abstract

A 23-year-old woman was admitted to our hospital for tumorous lesions in the abdomen. Enhanced abdominal CT scan revealed tumors with calcification at hepatoduodenal ligament and the mesentery of the jejunum. The QuantiFERON-TB Gold In-Tube test results were positive. She underwent an incisional biopsy for the mass lesion in the mesentery to confirm the diagnosis of tuberculosis by single-port laparoscopic surgery (SPLS). After adhesiolysis was performed between the tumor and the surrounding intestine, the incisional biopsy was conducted under direct vision at the umbilicus site. Then, the tumor wall was sutured laparoscopically. The biological and histopathological findings indicated mesenteric lymph node tuberculosis (MLNT) that had a score of 1 on the Gaffky scale, was PCR-positive, and was accompanied by caseous granulomas. MLNT presents a clinical dilemma for diagnosis. It generally appears to form a mass lesion that may require open surgery to confirm the diagnosis. Here we report a case in which a confirmed diagnosis of MLNT was made by SPLS. In view of the difficulty involved in total excisional biopsy of the lymph nodes, wedge resection of the cold abscess wall and suturing of the open wall should be performed to prevent Mycobacterium tuberculosis infection from disseminating to the intra-abdominal cavity.

Journal

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 74 (4), 952-957, 2013

Japan Surgical Association

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