Gastric tuberculosis with ulceriform clinical syndrome in 2 patients with a family history of ulcer
Dubarry, J.J.; Carles, J.; Bernard, J.P.; Faivre, J.; Dubarry, E.; Mineur, P.
Archives Francaises des Maladies de l'Appareil Digestif 56(5): 435-442
1967
ISSN/ISBN: 0003-9772 PMID: 5618818 Document Number: 5340
In case I, a prepyloric crater at fi rst appearing harmless, then malignant; for case II, a crater at the foot of the lesser curvature at the start of clinical history, finally disappearing under the effect of anti-ulcer treatment, later ulceriform attacks accompanied by an appearance of infiltration of the antral region of the lesser curvature, the persistence of which led, as in the fi ns case, to gastrectomy. The histology showed in case 1 the tubercular nature of the prepyloric lesion. In case II, a large pre-aortic and suprα-pancreatic ganglion with typical caseous tubercular lesions, the antral wall simply being the site of a clearly inflammatory state. In both cases, antitubercular treatment after gastrectomy; cure. In both cases, a father with gastric ulcer, without any other familial antecedent. A study of these two cases calls for some comment: gastric tuberculosis usually assumes the appearance of ulcer in those who are genetically predisposed to ulcer, a special case of ulceriform syndromes encountered in consanguineans of ulcer sufferers when affected by various digestive disorders (Cp. the thesis by our pupil Cler, Bordeaux, 1963); unless a simple Cruveilhier ulcer proved the point of entry of the Koch bacillus, presumably of the bovine type, carried by a diet rich in milk and dairy products. In case II, the large ganglion is perhaps the satellite of an inoculation canker which, in a patient predisposed to ulcer, has taken on the form of a Cruveilhier ulcer, as ephemeral as the real thing. Although much rarer in the small intestine, it is well known rince the tragedy of Lubeck in 1931 (77 babies died after ingestion of an attenuated Kiel type Koch bacillus) that the stomach may be the site of a primary complex.
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