[Differential diagnosis of disorders of intestinal resorption].
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The double contrast radiological technique involving duodenal intubation for the examination of the small intestine is described. The technical difficulties involved are discussed with ample illustration. This forms the basis for suggestions on the main indications for the technique in a correct diagnostic protocol.
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BACKGROUND: Abdominal tuberculosis has varied presentation and can be confused with other conditions. METHODS: We report our experience with 46 patients. Charts of patients managed during 1984-97 were reviewed. RESULTS: Fifty-two percent were women and mean age was 46 years. Presenting symptoms were as follows: fever 70%; abdominal pain 70%; weight loss 68%; abdominal swelling 67%; change in bowel habit 39%; anorexia 30%; and sweating 30%. Common physical signs were as follows: fever 73%; ascites 61%; abdominal mass 13%; and doughy abdomen 9%. Thirty percent of patients either gave past history of TB or presented with active TB of other sites. TB skin test was positive in only 27% of patients. CT scans of abdomen were abnormal in 80%, showing ascites, peritoneal lesions or enlarged nodes. Ascitic fluid was diagnostic for TB on smear/culture in 33%. Peritoneal biopsy was performed by laparoscopy or laparotomy in 61%. It was positive for ganulomas in 97% and for smear/culture in 68%. Forty-two patients recovered after receiving anti-TB therapy for 9-12 months. Four patients died. One died within 1 month of initiation of therapy due to extensive TB, and death in the other 3 was due to unrelated causes. CONCLUSION: Abdominal TB should be suspected in patients with fever, abdominal pain and ascites. This condition carries good prognosis if promptly diagnosed and treated.
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Gastrointestinal manifestations of both Behçet's disease and intestinal tuberculosis include the signs and symptoms of abdominal pain, weight loss, fever, vomiting, diarrhea and palpable mass in the right lower quadrant. We report the case of a male patient with Behçet's disease who had multiple ileal perforations due to miliary tuberculosis. It was suspected that the perforations were due to intestinal manifestation of Behçet's disease, but the final pathology report and chest X-ray one week after surgery demonstrated the presence of miliary tuberculosis. To our knowledge, this is the first reported case of Behçet's disease with intestinal perforation due to miliary tuberculosis.