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PubMed2005

[A clinical analysis of 57 cases of abdominal tuberculosis].

OBJECTIVE: To explore the clinical characteristics and diagnosis methods of abdominal tuberculosis. METHODS: The clinical characteristics of abdominal tuberculosis in 57 cases proved by histopathology between 1958-2004 were retrospectively analyzed. RESULTS: There were 39 cases of tuberculosis of the liver, 5 cases of the spleen, 8 cases of the pancreas, 3 cases of the stomach, 1 case involved both liver and spleen and 1 case involved both liver and stomach. Twenty-six patients were males and 31 female; with ages ranged from 17 to 68 years (mean 40.7 years) and most cases (71.9%) having extra-abdominal tuberculosis. Fever (75.4%), fatigue, anorexia, night sweating, weight loss (82.5%) and hepatosplenomegaly (57.9%) were the major clinical manifestations. Elevated erythrocyte sedimentation rate (ESR) (59.6%) and abdominal mass (64.9%) were found in most of the patients. CONCLUSIONS: The diagnosis of abdominal tuberculosis should be considered in all patients with fever of unknown origin, especially in those associated with hepatosplenomegaly, increased ESR and abdominal mass. Aspiration biopsy and laparotomy can provide correct diagnosis. The disease can be effectively treated with surgical intervention and antituberculous chemotherapy.

Adolescent↗
PubMed1975

[Sclerosis of the intestinal lymphatic vessels].

Fibrosis of the intestinal lymphatic vessels, produced in one case by tuberculosis and, in the other, by appendicitis and peritonitis, caused blockage of the main lymphatic vessels causing, clinically, a protein-losing enteropathy similar to that noted in congenital lymphatic diseases of childhood. In the laboratory, there was noted a fall in serum protein, lipid and cholesterol. A fat absorption test was very abnormal showing a flat curve. During laparotomy, there was discovered on the small intestine, the same layout of lymph vessels, resembling a lace network, as that observed in congenital malformations. Intestinal lymphography showed considerable stasis of the opaque substance and absence of injection of the lymph vessels in the mesentery.

Chylous Ascites↗
PubMed2006

[A case of lung tuberculosis which also incidentally found intestinal tuberculosis by 18F-fluorodeoxyglucose-positron emission tomography].

A 60-year-old women presenting with an abnormal shadow on a chest X-ray film was admitted to our hospital in June 2004. Her CT scan of the chest showed a cavitary mass shadow in the left upper lobe. FDG-PET was performed to examine whether this shadow was the lung cancer or not, and incidentally it showed an additional accumulation of FDG in the ileocecal resion. The colonoscopy was then carried out. Luminal narrowing with circumferential ulcer in the ileocecal resion could be observed, and pathological findings of the biopsy specimen revealed epithelioid cell granulomas. Partial lobectomy of the left upper lung was also performed, and the histological examination revealed typical pulmonary tuberculosis. Since the antituberculosis therapy was effective to the ileocecal lesion, we assert that the ileocecal lesion was intestinal tuberculosis.

Female↗
PubMed2006

[Lymphoid form of intestinal tuberculosis with miliary dissemination: case report].

Tuberculosis with the incidence 28-29/100000 residents still presents a major public health problem in Croatia. Miliary tuberculosis is uncommon cause of fever of unknown origin. Intestinal tuberculosis pose as diagnostic problem that can be identified by colonoscopy and/or explorative laparatomy involving histopathology and microbiology. A case is reported of a 40-year-old HIV negative patient admitted to the Department of Infectious Diseases after two weeks of fever, diarrhea, abdominal pain and weight loss. Biochemistry testing showed mild elevation of the erythrocyte sedimentation rate and increased serum aminotransferases. On admission, chest x-ray was normal and tuberculin skin test was negative. Crohn's disease was suspected. Computed tomography of the abdomen revealed solid infiltrative mass located retroperitoneally, along with enlarged lymph nodes. Explorative laparoscopy was necessary to confirm the diagnosis. Intraoperative specimens were referred for histopathologic and microbiologic examination, which proved the existence of granulomatous inflammation of the areas with caseous necrosis. Direct microscopy of the periappendicular abscess and Ziehl-Neelsen staining of a lymph node specimen confirmed the presence of an acidoresistant bacillus. The specimen culture on solid egg based agar (Löwenstein Jensen) and liquid broth (MGIT) showed the growth of Mycobacterium tuberculosis. Then the causative agent was cultured from all specimens: sputum, stool and urine. Repeat cheast x-ray, performed on day 30 of hospitalization, showed miliary dissemination to the lungs. The patient was treated with four antituberculotics (streptomycin, isoniazide, rifampin, ethambutol) and methylprednisolone for one month, then with isoniazide, rifampin and for 11 months ethambutol. Therapy led to a decrease of abdominal lymph nodes and absence of miliary lesions on chest radiography after two months of treatment. Intestinal tuberculosis has been almost forgotten in Croatia. The latest published cases referred to HIV infected patients. In less than 50% of patients with intestinal tuberculosis the lungs are also affected, which poses a diagnostic problem. Crohn's disease is the most common diagnostic problem. Histopathology of a specimen obtained on colonoscopy and/or explorative laparoscopy can often solve the dilemma, as also confirmed in our patient. Of diagnostic studies, computed tomography has the advantage of evaluating intestinal wall involvement, which is important for the early diagnosis of intestinal tuberculosis. Enteroclysis and irrigography provide diagnostic information in the advanced stage of intestinal tuberculosis. In a patient with fever, abdominal disorders and parameters which implicate granulomatosis hepatitis or Crohn's disease, the existence of abdominal tuberculosis is also possible. Computed tomography and biopsy obtained on colonoscopy for microbiology can help in making the diagnosis and initiating appropriate treatment.

Adult↗
PubMed1999

Extra-pulmonary tuberculosis in patients with fever of unknown origin: clinical features and diagnosis.

One hundred twenty-nine patients with extra-pulmonary tuberculosis admitted at the Abbassia Fever Hospital, NAMRU-3 during a seven year period (1991 to 1997) are described. Tuberculous peritonitis was diagnosed in 35 patients, tuberculous lymphadenitis in 32, intestinal tuberculosis in 19, genito-urinary tuberculosis in 14, skeletal tuberculosis in 13, disseminated miliary tuberculosis in 11, and splenic tuberculosis in 5 patients. The clinical picture included fever, and weight loss accompanied by anaemia and an elevated erythrocyte sedimentation rate in all patients.

Adolescent↗
PubMed1991

[Abdominal tuberculosis in patients with acquired immunodeficiency syndrome].

BACKGROUND: In individuals with HIV infection, extrapulmonary forms of tuberculosis are considered as opportunistic infections and are included in the diagnosis of AIDS. They often have atypical clinical features. Abdominal participation is uncommon and its diagnosis may be difficult. METHODS: The clinical, radiological and pathological features of patients with a diagnosis of AIDS with abdominal tuberculosis in a series of 254 AIDS cases in a general hospital from 1984 to October 1990 were reviewed. RESULTS: Tuberculosis developed in 104 (41%) of AIDS patients. In 25 (24%) the disease was exclusively pleuropulmonary and in 79 (76%) extrapulmonary tuberculosis was present, either alone or in association. Extrapulmonary tuberculosis was the first opportunistic infection in 66 AIDS cases (26%). The abdominal participation was demonstrated in 19 patients, with the following localizations: lymph nodes (9), liver (8), spleen (5), ileum (1) and peritoneum (1). Four patients with splenic tuberculosis also had multifocal nodular lesions. CONCLUSIONS: Abdominal participation was found in 19 of the 104 AIDS patients with tuberculosis (18%). Lymph node involvement was the most common type. Hepatosplenic tuberculosis had a miliary form or showed multifocal images in echography or computed tomography.

Abdomen↗
PubMed1991

The reappearance of abdominal tuberculosis.

Seventeen patients with abdominal tuberculosis were recently treated at our institution. Two distinct patient populations were identified--immigrants and individuals infected with the human immunodeficiency virus. Abdominal pain, weight loss and fever were the most common complaints, with abdominal tenderness and pyrexia the most frequent physical findings. Only five of 17 patients had concomitant pulmonary tuberculosis. A typical computed tomographic scan was helpful in the diagnosis. Diagnosis was made at emergency (five patients) or elective (six patients) laparotomy, by endoscopic (two patients) or percutaneous (three patients) biopsy or on the basis of roentgenologic and clinical evidence (one patient). All responded to antituberculous chemotherapy. With the spread of acquired immunodeficiency syndrome (AIDS), tuberculosis has become increasingly frequent in urban areas and it must be suspected in all immigrants and patients with AIDS presenting with abdominal complaints.

Abdomen↗
PubMed1990

[Lymphotropic chemotherapy of patients with tuberculosis of the lymph nodes, skin and abdominal organs].

Experience gained as a result of indirect endolymphatic chemotherapy of patients with tuberculosis of the skin, peripheral and mesenteric lymph nodes is presented. The above treatment is tolerated well by the patients and causes no local or general complications. The clinical effect is achieved 1-3 months earlier than with a traditional therapy which provides a significant drop in the inpatient period and the drug load. Incidence of exacerbations also becomes less. It is worthwhile to include lymphotropic chemotherapy into a complex of therapeutic measures both at the beginning of the treatment and in a torpid course of the disease.

Adult↗
PubMed1990

[Ileocecal and lymph node tuberculosis: a rare association in our area].

A case of ileocecal tuberculosis associated to lymphatic nodes TB, is presented. This association is not frequently observed in all series and isolated cases registered in medical literature. In this particular case, we comment on the pathogenic problems of primary intestinal TB and the importance of the systemic clinical suspicion to diagnose this, nowadays, rare problem in our area. Finally, we discuss the value of certain diagnosis criteria related to the actual therapy, in which the conservative character is dominant, this therapy also being applied to post-surgical fistula in some individual cases such as the one presented here.

Female↗
PubMed1990

Serodiagnosis of gut tuberculosis.

The efficacy of enzyme-linked immunosorbent assay (ELISA) in the diagnosis of gut tuberculosis was evaluated. The study included 95 patients with gut tuberculosis, 40 with pulmonary tuberculosis, 25 with non-tubercular intestinal diseases and 40 healthy controls. Mantoux response and antibody titre against PPD using ELISA were studied. The ELISA sensitivity in gut tuberculosis was 80% and in pulmonary tuberculosis 90%. It was also positive in 12% of patients with non-tubercular intestinal diseases and 5% of healthy controls. The sensitivity of Mantoux test in gut (77%) and pulmonary (84%) tuberculosis was comparable to that of ELISA. However, Mantoux test lacked diagnostic significance due to high positivity in non-tubercular disease patients (55%) and healthy controls (56%), whereas ELISA was highly specific (93%) for the diagnosis of gut tuberculosis.

Antibodies, Bacterial↗
PubMed1990

[Intestinal perforation occurring at the beginning of treatment: a severe complication of bacillary tuberculosis].

We report 2 cases of intestinal perforation caused by tuberculosis and affecting the small intestine in one case and the colon in the other case. The patients were men aged 49 and 51 years respectively. Both were cachectic and presented with advanced open pulmonary tuberculosis. Perforation in free peritoneal cavity occurred 2 and 8 days respectively after an antituberculous treatment was initiated. The outcome was rapidly fatal in both cases. Tuberculous enteritis has become rare, but it can still be observed in patients with severe open pulmonary tuberculosis, where the gastro-intestinal tract is contaminated by the large number of virulent mycobacteria swallowed. In such patients clinicians must be alert to abdominal premonitory signs. Intestinal perforations in free peritoneal cavity are uncommon. Most perforation are small, single or multiple, and located on the antimesenteric side of the terminal ileum. They may occur at any time, and particularly just after an antituberculous therapy has been instituted. Clinical presentation is one of acute peritonitis requiring emergency laparotomy. Mortality has been reduced by technical improvements, notably temporary enterostomy, but perforation remains a serious and often fatal complication of tuberculosis in patients with severe malnutrition.

Antitubercular Agents↗
PubMed1990

A rare cause of small bowel perforation by intestinal and peritoneal tuberculosis.

Tuberculosis of the intestine and peritoneum has become a rare disease. This is the result of a general decrease in pulmonary and extrapulmonary tuberculosis, rigorous BCG vaccination programs, and the eradication of tuberculosis in cattle. A case of tuberculosis in this frequent location, which was discovered unexpectedly during an emergency laparotomy, is reportet.

Aged↗
PubMed1989

[Abdominal tuberculosis and open lung tuberculosis caused by mycobacterium bovis].

Abdominal tuberculosis is a rare disease in Western countries and remains difficult to diagnose. The most frequent symptoms are abdominal pain, weight loss, fever, vomiting, constipation and/or diarrhea. Clinical findings include abdominal tenderness, a palpable mass (often in the right fossa due to ileocecal infection), paleness, cachexia and ascites. Suggested radiological investigations include plain abdominal film, upper GI-series and barium enema. Chest X-rays often show signs of either active or inactive tuberculosis. Sputum and gastric juice should be cultured. Coloscopy serves to sample specimens for histology and bacteriology and may help to confirm the diagnosis, which is, however, not ruled out by negative findings. The same holds good for peritoneal biopsy and laparoscopy. Bowel perforation and ileus are frequent complications and always require surgery, whereas uncomplicated cases can be treated by drugs only.

Adolescent↗