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PubMed1990

Gastrointestinal tuberculosis in patients with pulmonary tuberculosis.

Proven or suspected intestinal tuberculosis was diagnosed in 23 (46 per cent) of 50 patients with smear-positive, cavitating pulmonary tuberculosis. The diagnosis was regarded as proven in 14 patients and suspected in the remaining nine. The frequency of proven gastrointestinal disease increased with the severity of the pulmonary tuberculosis. Small intestinal disease was encountered in only two patients. Small mucosal lesions in the caecum were the most commonly detected pathological features. Colonoscopy was of particular value in establishing the diagnosis, which could not be predicted from the patients' abdominal signs or gastrointestinal symptoms.

Adolescent↗
PubMed1991

Unusual presentations of duodenal tuberculosis.

Gastrointestinal tuberculosis is still rampant in underdeveloped countries and can mimic other gastrointestinal (GI) disorders. Herein we report four cases of isolated proximal duodenal tuberculosis, without involvement of other parts of the GI tract. The clinical presentation in three of them resembled that of peptic ulcer disease, and one had features of gastric outlet obstruction. On investigation, one of these patients had a pyeloduodenal fistula. The limitations of clinical evaluation, radiology, and endoscopy are stressed, and the value of surgical biopsy is highlighted.

Adult↗
PubMed2006

Selective jejunal artery pseudoaneurysm embolization in a patient with massive gastrointestinal bleeding due to intestinal tuberculosis.

Gastrointestinal bleeding is a life-threatening manifestation of intestinal tuberculosis that is generally attributed to oozing of blood from the mucosal ulcers. We report a case of intestinal tuberculosis presenting with massive upper gastrointestinal bleeding from jejunal artery pseudoaneurysm diagnosed with angiography and successfully embolizated by histoacril (glue).

Adolescent↗
PubMed1998

[Intestinal tuberculosis and tuberculous peritonitis].

Gastrointestinal tuberculosis and tuberculous peritonitis are still considered a rare disease in Japan. A high index of suspicion must be maintained to make an exact diagnosis. It also must be kept in mind that little evidence of active or healed tuberculosis is detectable on chest x-ray. The jejunoileum and ileocecum are most commonly affected in the gastrointestinal tuberculosis. Abdominal pain and abdominal tenderness are present in most patients. An abdominal mass is often palpable in the right lower quadrant. The most valuable diagnostic study is colonoscopy with biopsies. In tuberculous peritonitis, an abdominal swelling is the most common symptom. Laparoscopy with directed biopsy is an excellent study for diagnosis. The levels of ascites adenosine deaminase are also useful for diagnosis.

Humans↗
PubMed1996

Rectal stricture: a complication of tuberculosis.

Tuberculosis of the rectum is rarely reported, even from areas where tuberculosis, and gastrointestinal tuberculosis in particular, is prevalent. The authors report a case of long tubercular stricture of the rectum and distal part of the sigmoid colon in a 12-year-old girl. Because of nonspecific symptoms and noncharacteristic radiological and endoscopic features, the diagnosis of this rare entity rests mainly on histological evidence of the classical tubercle in a surgical biopsy specimen.

Antitubercular Agents↗
PubMed1978

Gastrointestinal tract tuberculosis: a study of 102 cases including 55 hemicolectomies.

Tuberculosis continues to be a major health problem in India. Our experience of 102 cases of gastrointestinal tract tuberculosis is presented. Eighty-one of these patients experienced obstructive symptoms, 62 had radiographic evidence of intestinal obstruction, and four had bowel perforation. Lymphadenopathy was present in 16 patients and pulmonary tuberculosis in 28. The commonest sites of bowel involvement were ileo-caecal, ileum and ascending colon. Duodenal lesions were seen in three cases and in another three there was isolated appendicular involvement. Right hemicolectomy was necessary in 55 of the 74 patients who had surgical exploration. Histopathological reports were available in 88 subjects. The various radiographic manifestations of tuberculosis of the bowel are discussed. Radiologically and sometimes even on histopathology, differentiation of ileo-caecal tuberculosis from Crohn's ileo-colitis may prove impossible.

Adolescent↗
PubMed1980

Non-respiratory tuberculosis in Canada. Epidemiologic and bacteriologic features.

Of the total cases of tuberculosis reported in Canada between 1970-1974, approximately one-sixth (3671 cases) involved primarily non-respiratory organs. Common diagnostic entities were genitourinary tuberculosis (1516 cases), lymphadenitis (1083 cases), bone and joint tuberculosis (555 cases), gastrointestinal tuberculosis (155 cases) and meningitis (138 cases). The remainder (224 cases) involved a wide variety of organs. Between 1967 and 1977 the morbidity rates of most non-respiratory manifestations steadily declined, the decline in meningitis being particularly marked. In contrast, lymphadenitis did not decline to the same extent, reflecting changing immigration patterns. The major diagnostic entities differed in their age and sex patterns and in their contribution to total cases by birthplace and ethnic group. In particular, the preponderance of lymphadenitis in females, and in the Asian-born was striking. Mycobacterium bovis was isolated infrequently and bacillary resistance to antituberculosis drugs was also uncommon. In a substantial proportion of cases, active tuberculosis was present concurrently at another site, or there was historical or radiologic evidence of previous active tuberculosis. Despite this additional evidence, delay and failure of diagnosis were common. An increased clinical awareness of tuberculosis is required, particularly in view of the often enigmatic presentation of non-respiratory disease.

Age Factors↗
PubMed2004

Gastrointestinal luminal tuberculosis: establishing the diagnosis.

BACKGROUND AND AIM: To study the profile of gastrointestinal luminal tuberculosis (GITB) patients who have been treated on a confirmed and a presumptive diagnosis. METHODS: A total of 260 patients who had an initial diagnosis of GITB were included in this retrospective analysis. Clinical, radiologic, endoscopic, histopathologic and microbiologic features of these patients were studied in detail. RESULTS: GITB was confirmed in 66.5% patients (cGITB), while 29.5% had presumed GITB (pGITB). In 3.9% patients, Crohn's disease (CD) was misdiagnosed initially as GITB. There was no significant difference in the clinical and radiologic features except a higher incidence of a radiologically abnormal ileocecal region in cGITB patients. Endoscopic biopsies from ulcerated masses and ulcers had the highest yield of confirmation (100% and 68%, respectively) when subjected to histopathology, acid-fast bacilli smear and culture studies. Confirmed diagnosis was obtained in 100% of cases occurring in the upper gastrointestinal tract, 66% of cases in the ileocecal region/colon and 40% of cases that had small bowel involvement. In 21% of cases, extraluminal sites helped to confirm the diagnosis. As the presence of diarrhea, bleeding, fistulae, perianal disease and extraintestinal manifestations favored a diagnosis of CD, the presence of these features initially or on subsequent follow up helped to minimize the misdiagnosis of GITB. CONCLUSIONS: As a differential diagnosis, CD must be ruled out before starting treatment for GITB. In our study, an intense search for histologic and microbiologic proof of the presence of TB from luminal and extraluminal sites established the diagnosis in 66.5% of cases. Surgery for establishing the diagnosis should be reserved for complicated cases.

Adult↗
PubMed1993

Tuberculosis of the gastrointestinal tract and peritoneum.

Gastrointestinal and peritoneal tuberculosis remain common problems in impoverished areas of the world, but is relatively infrequent in the United States. A resurgence of tuberculosis in America since the mid-1980s means that clinicians will continue to see cases. Immigrants and AIDS patients are two population groups at particular risk for abdominal tuberculosis in this country; the urban poor, the elderly, and Indians on reservations are others. The symptoms and signs of GI and peritoneal tuberculosis are nonspecific, and unless a high index of suspicion is maintained, the diagnosis can be missed or delayed resulting in increased morbidity and mortality. Only 15-20% of patients have concomitant active pulmonary tuberculosis. Tuberculous peritonitis needs to be considered in all cases of unexplained exudative ascites. Laparoscopy with directed biopsy currently is the best way to make a rapid specific diagnosis. The measurement of ascites adenosine deaminase levels represents a major diagnostic advance in tuberculous peritonitis, particularly in underdeveloped areas where the affliction is common and laparoscopy may not be available. With greater experience, this testing procedure could also supersede invasive studies in western countries, particularly in high-risk patient groups. The commonest sites of tuberculous involvement of the GI tract are the ileocecal area, the ileum and the colon, although any area of the gut can be involved. If the area of affected gut is within reach of the flexible endoscope, rapid diagnosis may be possible with biopsy (if acid-fast bacilli or caseating granulomas are seen). Not infrequently, the disease is not considered until it is diagnosed at the time of surgery. In countries with a high prevalence of intestinal tuberculosis, a therapeutic trial of antituberculous drugs may be reasonable if the clinical picture is compatible. The diagnosis of tuberculous enteritis can be taken as highly probable if the patient responds to treatment and this is followed by no recurrence. Serologic tests for diagnosing tuberculosis are being improved and evaluated in intestinal tuberculosis. Gastrointestinal and peritoneal tuberculosis are treated with antituberculous drugs. Surgery is reserved for complications or uncertainty in diagnosis. Six-, 9-, and 18- to 24-month regimens are all effective for extrapulmonary tuberculosis. Standard therapy of at least 9 months duration is also effective in most AIDS patients who are started on appropriate treatment in a timely fashion and who are compliant. The potential for multidrug resistance needs to be kept in mind and accounted for.

Humans↗
PubMed1979

Spontaneous tuberculous enteroumbilical fistulas.

Gastrointestinal tuberculosis in children is an uncommon condition. Obstruction and hemorrhage are the known common complications of tuberculous enteritis. Perforation is an uncommon complication whereas tubercular enterocutaneous fistula is a still rarer complication. Five children with spontaneous tubercular enteroumbilical fistulas are being reported. All were below the age of 10 years, the youngest being 15 months old. Four children had conservative treatment with antitubercular drugs and one had exploration, resection of gut and excision of fistula. All the children who had conservative treatment survived whereas the child who underwent surgery died in the postoperative period. We feel that the conservative management is the treatment of choice in cases of established tubercular enterocutaneous fistulas.

Child↗
PubMed1980

Tuberculous enteritis and peritonitis. Report of 36 general hospital cases.

We studied 36 patients with gastrointestinal tuberculosis: 21 had peritonitis, 11 had enteritis, and four had both. Diagnostic criteria were (1) caseating granulomas or positive smear or culture from an abdominal specimen; (2) culture-proved pulmonary tuberculosis plus ascitic fluid containing protein, greater than 3.0 g/dL, and more than 50% lymphocytes, or granulomatous enterlitis on x-ray studies that resolved with antituberculous therapy. In only four of 15 patients with enteritis was the disease confined to the ileocecal region. Fourteen patients (40%) had complications: bowel obstruction in ten, perforation in six, and fistula in five. Five of these died. Two perforations and one death followed paracentesis and needle biopsy. Tuberculous peritonitis can be diagnosed without biopsy when lymphocytic exudative ascites responds to antituberculous chemotherapy given for concurrent culture-proved pulmonary tuberculosis. Patients with pulmonary tuberculosis and persistent abdominal complaints who have granulomatous enteritis should be considered to have tuberculous enteritis. Surgery is reserved for bowel obstruction, perforation, fistula, or a mass that does not resolve with drug therapy.

Adult↗
PubMed1991

[Diagnosis of tuberculosis of gastrointestinal tract].

The article deals with the difficulties of establishing the diagnosis of abdominal tuberculosis. Seven patients were under observation. In 5 the diagnosis was made histologically after operative intervention. In 6 patients abdominal tuberculosis was combined with a specific process in the lungs. Two cases of tuberculosis of the stomach, intestine, and mesenteric lymph nodes following a course resembling that of an abdominal "tumor" are described. For the exclusion of tuberculosis it is recommended that fluorographic examination of the lungs should be included in the complex preoperative management of patients.

Adult↗
PubMed1993

[Composition of circulating lymphocyte pool in patients with pulmonary tuberculosis and gastrointestinal diseases].

A total of 133 new-onset cases with destructive tuberculosis of the lungs with and 34 such cases without gastrointestinal affections as well as 26 gastroenterological patients free of tuberculosis were studied immunologically. In patients suffering from the combination of the above diseases there appeared more profound disorders of immunity attributed to the effect of the associated disease.

Gastrointestinal Diseases↗