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Incidence of gastrointestinal tuberculosis increases in the western world. Exact epidemiological data about this rare extrapulmonological disease are not available in Hungary. Three advanced cases with intestinal tuberculosis have been reported, all of them recognised during surgery due to complications. The clinicopathological correlations are briefly reviewed, and the importance of early diagnosis is emphasized.
Thirteen patients with gastrointestinal tuberculosis (GITB) were treated at our hospitals from 1977-1987. Ten of these patients were seen during the last four years. Three patients required operative intervention for management of complications of their disease. This review discusses the presentation, diagnosis, and operative management of GITB. The authors feel that the increasing prevalence of GITB noted in their institution is primarily the result of the growing prevalence of mycobacterium tuberculosis pneumonia across the nation. With the recent influx of patients from areas of endemic tuberculosis and the increasing number of immunosuppressed patients, a surge in the number of patients presenting with GITB is likely to occur in the United States. Surgeons must be conversant with the diverse clinical features and operative management of this disease.
Gastrointestinal tuberculosis has declined markedly in frequency since the introduction of antituberculous therapy. As a result, the diagnosis is often delayed in North American patients. Segmental colonic disease, especially in the absence of pulmonary tuberculosis, is often difficult to differentiate from Crohn's disease or a neoplasm. We describe a case of colonic tuberculosis mimicking carcinoma of the hepatic flexure of the colon.
The hemograms of 38 patients with gastrointestinal tuberculosis (GIT) and of 47 patients with pulmonary tuberculosis variations were comparatively studied. Reliably valuable differences were registered in the frequency rate of deviations from the norm and in the mean values of hemograms' parameters of GIT patients, i.e. a more pronounced lower count of erythrocytes, hemoglobin and of monocyte-lymphocyte index as well as an accelerated ESR and a disassociation between the accelerated ESR and the normal leukocyte count.
UNLABELLED: Gastrointestinal tuberculosis is a rare form of extrapulmonary tuberculosis and its diagnosis can be difficult. AIMS: To analyze the diagnostic and therapeutic characteristics of gastrointestinal tuberculosis. METHODS: Retrospective study from 17 cases collected in 4 hospitals in Seine Saint-Denis between 1987 and 2002. RESULTS: Seventeen cases and 19 localizations were collected: small intestine (N = 7), ileocecum (N = 6), colon (N = 4) and gastroduodenum (N = 2). Two patients had two localizations. Mean age was 43.9 years. Subjects from immigrant populations (76.5%) were preferentially affected. Twenty-three percent of patients (13 tested) were infected by human immunodeficiency virus. Weight-loss and general weakness (88%), abdominal pain (88%), fever (59%), nausea/vomiting (53%) were the predominant symptoms. The delay in diagnosis was 82 days (range: 7-180) and time before specific treatment 31.6 days (range: 7-90). Histological evidence of caseating granuloma was found in six patients. Mycobacterium tuberculosis was detected in six. Digestive imaging was abnormal in 15 patients. Mesenteric lymph nodes were the most common associated site of tuberculosis (N = 8, 47%). Mean duration of treatment was 8.2 months (range: 6-12). Thirteen patients were cured, three died and one was lost to follow up. CONCLUSION: Gastrointestinal tuberculosis is not an uncommon diagnosis in the north-eastern Parisian area, especially among immigrant populations and immunodeficient patients. The most frequent localizations are the small intestine and ileocecum. Diagnosis can be made by pathology and/or bacteriology on endoscopic and/or surgical biopsy samples.
The gastrointestinal tuberculosis is a rare disease and it can mimic a large variety of gastrointestinal diseases. The most common site of gastrointestinal tuberculosis is the ileocoecal region followed by the ascending colon and jejunum. Complications are an absolute indication for surgical intervention. Perforation is an extremely uncommon complication of mycobacterium tuberculosis infection.
We present 11 cases to illustrate the protean presentations of gastrointestinal tuberculosis. The patients presented with perianal fistula, appendicitis, ascites, rectal, intestinal or gastric 'growth', "ulcerative colitis", or recurrent anemia. In some of these cases there was no conclusive proof of infection with Mycobacterium tuberculosis but they responded well to empirical treatment with anti-tuberculous therapy. These cases illustrate that because signs and symptoms of intestinal tuberculosis are non-specific and even histology can be misleading, the diagnosis of gastrointestinal tuberculosis requires a high index of suspicion. A therapeutic trial of antituberculous drugs should be considered for patients with a high clinical suspicion of tuberculosis.
The diagnosis of gastrointestinal tuberculosis (GITB) is often delayed, increasing the morbidity associated with this treatable condition. In this case series, the clinical presentations and outcomes of 18 patients with GITB are reviewed. Our aim was to elucidate the presenting signs and symptoms of GITB so as to help physicians improve their ability to make this diagnosis. Cases were gathered retrospectively over an 8-year period from Santa Clara Valley Medical Center, San Jose, California. Sources of information included patient records from our TB clinic and our hospital from 1989 to 1997. Of the 18 patients, 16 had a definitive diagnosis of GITB made from histology and/or culture from an abdominal source. In the remaining two patients, a presumptive diagnosis of GITB was made based on the co-occurrence of abdominal signs and symptoms, response to antituberculous therapy, and Mycobacterium tuberculosis identified at a nonabdominal site. The most common clinical presentation was a triad of abdominal pain, fever, and weight loss. This triad was present in 8 of 18 patients. Seven patients presented with two of these signs and symptoms, two had abdominal pain alone, and one presented with other symptomatology. Time to diagnosis ranged from 2 days to 11 months, with a mean time to diagnosis of 50 days. These findings suggest that the diagnosis of GI and hepatic TB is often delayed. Possible reasons for delay include nonspecific signs and symptoms and failure to consider TB in the initial differential diagnosis. Once diagnosed, the outcome of GITB in this series was favorable.
BACKGROUND: Perforation and fistulae, though uncommon, are serious complications of gastrointestinal tuberculosis. Patients with acute tuberculous perforation are subjected to surgery, whereas localized perforation and fistulae with subtle clinical signs are detected by barium contrast examination. There has been no report on radiological series regarding the incidence of perforation and fistulae, detected by barium contrast studies. MATERIAL AND METHODS: A retrospective analysis of barium contrast studies of 684 proven cases of gastrointestinal tuberculosis seen over a period of 15 years was done to detect the incidence of perforation and fistulae. RESULTS: Fifty-two patients (7.6%) with localized perforation and fistulae were seen. Twenty-eight patients had evidence of perforation, and 24 patients showed fistulae formation. The most common site of perforation and fistulae was the small bowel followed by the colon. Associated abnormalities noted were ulcerations, strictures, nodular filling defects and extrinsic compression. CONCLUSION: Perforation and fistulae along with other associated abnormalities of the gastrointestinal tract are suggestive of tuberculosis, particularly in a population predisposed to tuberculous infection.
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Review of biopsy specimens showed that a patient incorrectly diagnosed 7 years ago as having Crohn's disease actually had histologically proven gastrointestinal tuberculosis of 7 years' duration. It is significant that gastrointestinal tuberculosis and Crohn's disease can mimic each other not only in their clinical, radiologic, and histologic manifestations but also temporally. We discuss the interrelationship between AIDS, tuberculosis, and inflammatory bowel disease.
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INTRODUCTION: Intestinal tuberculosis usually is not contemplated as a possible cause of chronic abdominal pain; nevertheless, incidence of this disease is increasing even in well-developed countries. MATERIALS AND METHODS: Four patients with intestinal tuberculosis who required surgical treatment. RESULTS: All patients had a history of chronic abdominal pain, presented acute complications of the disease, and required surgery. Three patients had AIDS and the remaining patient had chronic renal failure. CONCLUSIONS: Intestinal tuberculosis is a disease that should be considered as possible cause of chronic abdominal pain in patients with altered immunology.
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