Abstract
A 43-year-old female was admitted to our hospital because of hematemesis and tarry stool. She sometimes had complained of nausea and vomiting for 4 years before the admission. She was moderately anemic and CRP, fecal occult blood and PPD were positive. A chest X-ray picture was noncontributory. Hypotonic duodenography disclosed an irregular shaped ulcer and a stricture of the third portion of the duodenum. Similarly, duodenoscopy showed an irregular and shallow ulcer with a marked stenosis. The histopathology of the biopsy specimen revealed a caseating epithelioid granuloma containing Langhans' giant cells. Tubercle bacilli were recognized in the cultured biopsy specimen from the ulcer bed. The patient was diagnosed to have tuberculosis of the duodenum and antituberculous chemotherapy was then started. The patient condition was stable for 45 days and she again complained of severe vomiting after meals. A repeated hypotonic duodenography demonstrated that the ulcer healed but the stricture worsened. By-pass operation (gastrectomy and gastrojejunostomy) was performed. Thereafter, the patient was continued to have antituberculous chemotherapy for 1 year. The postoperative course was uneventful.
