[Intestinal perforation during ileo-cecal tuberculosis].
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Gastrointestinal Diseases↗
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Results for “TUBERCULOSIS, GASTROINTESTINAL”
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Peritonitis in India--a decade's experience.
Generalised peritonitis is a common and dreaded surgical emergency. Its tropical spectrum continues to be different from its western counterpart. The study represents a retrospective analysis of 250 cases of peritonitis managed surgically over a decade at a large referral surgical unit at New Delhi. Perforations of the upper gastrointestinal tract viz: duodenal ulcer, enteric perforations etc. constitute the majority unlike western series where lower gastrointestinal tract perforations predominate. Despite significant delays in presentation, the overall prognosis remains comparable to the western figures. A comparatively younger age group involved may be responsible for better outcome.
Adult↗
Malrotation of the gut with tuberculous stricture.
Malrotation of the gut is a congenital anomaly of the gastrointestinal tract and usually present with obstruction in early childhood. Late presentation may come into light for associated pathology. We report a case that had developed obstruction due to tuberculous stricture and not due to the anomaly itself.
Adult↗
[Three cases of mycobacteriosis with gastrointestinal localization].
The authors present three patients having primary microbacterial infections which involved the gastrointestinal tract. A short survey of the clinical features and the difficulties arriving at definitive diagnosis is given. They discuss the differential diagnostic problems in each case--without an unequivocal bacterial findings--on the basis of histologyc data and of therapeutic response which ultimately proved the mycobacterial nature of the infection.
Adolescent↗
Intestinal tuberculosis: an analysis of 346 cases diagnosed by routine intestinal radiography on 5,529 admissions for pulmonary tuberculosis, 1924-29.
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Gastrointestinal Diseases↗
Radionuclide scintigraphy in tuberculous enteritis.
Scintigraphy with indium-111 labeled leucocytes and gallium-67 citrate was performed on 6 patients with proven tuberculous enteritis. The ability of both techniques to visualize areas of disease in this condition was demonstrated. When compared with endoscopy (either upper gastrointestinal endoscopy or colonoscopy), Ga-67 citrate had a sensitivity of 0.80 and a specificity of 1.00. The sensitivity and specificity of In-111 labeled leucocytes was 0.60 and 0.96, respectively. The superiority of Ga-67 over In-111 was statistically significant. Positive scintigrams were obtained despite prior treatment with antituberculous chemotherapy.
Adult↗
Special histologic stains are rarely beneficial for the evaluation of HIV-related gastrointestinal infections.
During a 28-month period, endoscopic mucosal biopsy specimens from all HIV-infected patients were submitted for routine histologic evaluation. Immunoperoxidase staining for cytomegalovirus and herpesvirus antigens (esophagus), mycobacterial and fungal staining, and Gram staining of mucosal biopsy specimens were done. Special fungal and acid-fast stains were selectively performed in patients with absolute CD4 cell counts of less than 200 cells per microliter (200 x 10(6)/L) and/or with diarrhea and or wasting syndrome. Treatment was based on the endoscopic and histologic findings, and long-term follow-up was performed. The 121 symptomatic HIV-infected patients underwent 221 upper and/or lower endoscopies with 285 biopsy sites. The sensitivity and specificity of H&E staining for the diagnosis of gastrointestinal cytomegalovirus were 97% and 100%, respectively. The results of fungal and mycobacterial stains neither altered therapy nor identified previously undiagnosed infections in any patient. Long-term follow-up revealed no patient in whom an infection was missed on routine H&E, which affected outcome. Routine H&E staining is accurate for the diagnosis of gastrointestinal opportunistic infections in HIV-infected patients. Special histologic stains for fungal, mycobacterial, and viral infections did not increase the diagnostic yield or alter medical therapy but doubled the costs.
AIDS-Related Opportunistic Infections↗
Mucosa-associated lymphoid tissue (MALT) lymphoma combined with tuberculous enteritis at the same site in the jejunum.
Mucosa-associated lymphoid tissue (MALT) lymphoma is derived from the marginal zone B-cell compartment and can be found at a wide variety of extranodal sites, most frequently at the gastrointestinal site. Recent clinicopathologic studies suggest a relationship between MALT lymphoma and chronic inflammatory disorders, such as Helicobacter pylori infection in the stomach or autoimmune disorders, such as Sjögren's syndrome in the salivary glands. Primary gastrointestinal MALT lymphomas most commonly arise in the stomach and less often in the small and large intestine. Recently we experienced a case who had MALT lymphoma combined with tuberculous enteritis at the same site (jejunum) confirmed by exploratory laparotomy. We suspect that there may be some relationship between MALT lymphoma and chronic inflammatory process of mycobacterial tuberculous enteritis.
Disease-Free Survival↗
A review of ultrasound-guided percutaneous biopsy of the gastrointestinal tract in HIV-infected patients.
OBJECTIVE: To illustrate the use of percutaneous ultrasound-guided biopsy of the gastrointestinal tract in HIV-infected patients to obtain a tissue diagnosis. DESIGN: The technique was used in relation to relevant clinical situations in which a diagnosis may have only been reached by open biopsy. METHOD: Three HIV-infected patients with suspected gastrointestinal tract lesions underwent percutaneous ultrasound-guided biopsy under local anaesthetic. RESULTS: A tissue diagnosis was made in each case resulting in initiation or continuation of appropriate therapy and avoided the need for open biopsy under general anaesthetic. CONCLUSION: Although the number of patients undergoing the procedure in this series was small, the technique has so far been shown to be safe and effective with few complications.
AIDS-Related Opportunistic Infections↗
Emphysematous cystitis in a patient presenting with paradoxical arterial embolism and intestinal mycobacteriosis without evidence of diabetes.
We describe the case of a 72-year-old woman who displayed massive multiple intramural gas collections of the bladder wall as an incidental finding on CT. The patient presented with critical ischemia of the left leg caused by paradoxical arterial embolism, raised corpuscular sedimentation rate, anemia by gastrointestinal blood loss, hypoproteinemia, diarrhea, malabsorption, and exudative enteropathia caused by mycobacterial ileocolitis. The patient had no dysuria and there was no evidence of diabetes. The intramural gas collections of the bladder wall, as shown by CT, were compatible with emphysematous cystitis. Urine samples proved infection by a multi-resistant strain of E. coli. Emphysematous cystitis is a rare form of bladder infection that can be diagnosed by plain-film radiograms or CT.
Aged↗
Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients.
PURPOSE: To prospectively evaluate multi-detector row helical computed tomographic (CT) enteroclysis for the depiction of small-bowel diseases. MATERIALS AND METHODS: The study group included 107 patients who were suspected of having small-bowel tumor (n = 8), active inflammatory small-bowel disease (n = 18), unexplained gastrointestinal bleeding (n = 36), refractory celiac sprue (n = 14), and low-grade small-bowel obstruction (n = 31). A nasoenteric tube was positioned into the duodenojejunal junction by using fluoroscopic guidance and water was infused with a pressure-controlled pump. After intravenous administration of 120 mL of iodinated contrast material, multi-detector row helical CT enteroclysis images were obtained with 4 x 2.5 mm collimation (four detector rows and 2.5-mm section thickness). Multi-detector row helical CT enteroclysis findings were analyzed by two readers working in consensus. Findings were compared with the results of endoscopy, enteroscopy, videocapsule endoscopy, histopathologic analysis, or clinical follow-up. RESULTS: Multi-detector row helical CT enteroclysis was well tolerated in 106 patients; one patient complained of abdominal pain after the examination. Multi-detector row helical CT enteroclysis allowed the diagnosis of small-bowel masses (n = 21), active Crohn disease (n = 9), small-bowel tuberculosis (n = 2), small-bowel lymphoma complicating celiac disease (n = 4), and confirmed low-grade small-bowel obstruction (n = 12). Multi-detector row helical CT enteroclysis demonstrated normal findings in 60 patients. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of multi-detector row helical CT enteroclysis were 100%, 95%, 97%, 94%, and 100%, respectively. CONCLUSION: Multi-detector row helical CT enteroclysis allows depiction of small-bowel diseases in patients suspected of having small-bowel conditions.
Adolescent↗
Terminal ileitis associated with Mycobacterium avium-intracellulare infection in a homosexual man with acquired immune deficiency syndrome.
A 38-yr-old homosexual man developed fever, diarrhea, and weight loss. An upper gastrointestinal examination revealed terminal ileitis, and stains of stool revealed acid-fast bacilli that were subsequently identified as Mycobacterium avium-intracellulare. Antimycobacterial therapy was associated with weight gain and loss of fever and diarrhea. Several months later, cutaneous Kaposi's sarcoma was observed. When the patient developed strictures in the terminal ileum, a surgical resection was performed. Numerous granulomas and acid-fast bacilli, later identified as M. avium-intracellulare, were present in the resected terminal ileum. This report demonstrates that infection of the terminal ileum with M. avium-intracellulare in a patient with acquired immune deficiency syndrome can present with a clinical and radiologic picture resembling Crohn's disease. It also demonstrates symptomatic improvement of this infection temporally related to the administration of antimycobacterial therapy and the ability of an acquired immune deficiency syndrome patient to tolerate major abdominal surgery.
Acquired Immunodeficiency Syndrome↗
Phenotypic and genomic analyses of the Mycobacterium avium complex reveal differences in gastrointestinal invasion and genomic composition.
Mycobacterium avium and Mycobacterium intracellulare are closely related organisms and comprise the Mycobacterium avium complex. These organisms share many common characteristics, including the ability to cause life-threatening respiratory infections in people with underlying lung pathology or immunological defects and occasionally in those with no known predisposing conditions. However, the ability to invade the mucosa of the gastrointestinal tract and cause disseminated disease in AIDS patients has not been epidemiologically linked to M. intracellulare and appears to be unique to M. avium. We compared the abilities of M. avium and M. intracellulare to tolerate the acidic conditions of the stomach, to resist the membrane-disrupting activity of cationic peptides, and to invade intestinal epithelial cells in vitro and in vivo. We observed that M. avium and M. intracellulare were both tolerant to the acidic conditions encountered in the stomach and resistant to cationic peptides. However, when strains of M. avium and M. intracellulare were examined for their ability to enter cultured human intestinal cells or mouse intestinal mucosa, we observed that M. avium could invade more efficiently than M. intracellulare. To elucidate the basis of this pathogenic difference and identify genes involved in the invasion of the intestinal mucosa, we performed chromosomal DNA subtractive hybridization using M. avium and M. intracellulare chromosomal DNAs. In all, 21 genes that were present in M. avium but absent in M. intracellulare were identified, including some that may be associated with the ability of M. avium to invade the intestinal mucosa.
Animals↗
Response of tuberculous stricture to antituberculous treatment.
Tuberculous infection of the gastrointestinal tract results in a variety of histopathological lesions. Some patients develop intestinal strictures and present with subacute intestinal obstruction. The treatment is controversial and vary from a trial of antituberculous drugs to early surgery:the response to medical therapy is not clear. To examine this issue the present prospective therapeutic trial was carried out on 39 patients with symptoms of bowel obstruction and radiological evidence of intestinal stricture. All patients were treated with conventional antituberculous drugs (streptomycin, rifampicin, and isoniazid) under close supervision. Thirty four (87%) patients completed the trial, five were lost to follow up. Thirty one (91%) of these showed significant clinical improvement:26 became completely symptom free, while the remaining five complained of only vague abdominal discomfort. Only three (8%) patients failed to respond to treatment and were subjected to surgery. Barium series were repeated in 23 of 31 who completed the treatment; the remaining eight refused further investigations. Complete resolution of the radiological abnormality was seen in 16 (70%) patients. In the remaining seven (30%) the stricture persisted; in two of these the treatment was continued for another year and both showed substantial radiological improvement. It is concluded that most patients with tuberculous strictures respond well to medical treatment and surgery should be resorted to only if drug therapy fails.
Adolescent↗
Gastric tuberculosis with concomitant stromal tumour of stomach (GIST).
Gastric tuberculosis is an extremely rare condition because of unfavorable circumstances in stomach due to low pH, high motility and lack of lymphoid tissue. All these discourage the development of tuberculous lesion. Similarly, simultaneous stromal tumour of stomach is also a rare entity. We present a rare case of tuberculosis of stomach with no evidence of pulmonary involvement and a concomitant stromal tumour of the stomach. This unique case illustrates the need for a high index of suspicion in order to diagnose this rare condition, as this can present in patients with no particular risk factors or minimal symptoms.
Female↗
Caecal amoeboma simulating malignant neoplasia, ileocaecal tuberculosis and Crohn's disease.
We report two cases of amoeboma of caecum. The patients were initially diagnosed with acute appendicitis but a large cecal mass was found on surgery, giving the gross impression of tumor, Ileocaecal tuberculosis or Crohn's disease necessitating right hemicolectomy. On histopathological examination, the mass was found to be 'Amoeboma'. Mode of presentation, clinical examination and operative findings are presented along with the review of literature.
Acute Disease↗
Skip lesions in intestinal tuberculosis.
A case of a young lady is presented having acute intestinal obstruction due to multiple, discrete strictures throughout the small intestine. Histopathology confirmed the diagnosis of tuberculosis. Anti-tuberculosis therapy was started which resulted in complete remission. Discrete skip strictures in small intestines are typically seen in Crohn's disease, and are unusual for tuberculosis.
Adult↗