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PubMed1992

Intestinal tuberculosis: findings on double-contrast barium enema.

Seven cases of intestinal tuberculosis in an active stage were studied by the double-contrast barium enema (DCBE) method. Formerly, diagnosis of intestinal tuberculosis in the early stage by single-contrast barium enema (SCBE) and barium meals was based on functional phenomena, such as spasm and hypermotility of the ileocecal region. Presently, this can be better accomplished by DCBE. DCBE enables the detection of shallow ulcers with their characteristic elevated margins. These ulcers are frequently slim and transversally oriented. Confluence of ulcers may create whole girdle ulcers or affect entire segments. In more advanced stages, characteristic deformities, also evident by SCBE, such as symmetrical annular stenoses, shortening, retraction, pouch formation, and the frequently observed pathology of the ileocecal valve and the cecal region, acquire a new dimension with DCBE.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Intestinal tuberculosis in AIDS.

The radiological appearance of intestinal tuberculosis (IT) in six patients with AIDS is presented. Involvement of the ileocecal segment (five cases), cecum (four cases), and duodenum (one case) was seen on computed tomographic (CT) or barium studies. There were no significant differences in radiological manifestations of IT among patients with or without AIDS, but all six patients had an advanced stage of their disease at the time of diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Segmental tuberculosis of the distal colon: radiographic features in 7 cases.

The radiographic features of 7 cases of segmental colonic tuberculosis are described and illustrated. The lesions are generally short (5--7 cm) and may involve any part of the colon. They present radiographically as segmental granulomatous colitis or as annular, ulcerated lesions mimicking colonic carcinoma. Cases with sinus tract formation, severe narrowing, marked distortion, and fixation may occur. The association with pulmonary tuberculosis is common but not universal. The clinical findings are nonspecific, but the age group affected is mainly that of young adults. A short review of the pertinent literature is presented.

Adolescent↗
PubMed1989

Single tuberculous stricture in the jejunum: report of 2 cases.

Intestinal tuberculosis is now considered rare. It usually involves the ileocecal region and often produces multiple ulcers in the small intestine. This is a report of 2 patients who presented with a single tuberculous stricture in the jejunum, an exceedingly rare manifestation of this disease. The stricture in each case consisted of a short girdle ulcer with irregular margins, detected by double-contrast studies of the small intestine.

Constriction, Pathologic↗
PubMed1995

Isolated sigmoid tuberculosis. Report of a case.

PURPOSE: To heighten awareness of colonic tuberculosis (TB) as a once rare disease that is undergoing a resurgence in the United States. METHODS: Report of a case of isolated sigmoid tuberculosis with a brief literature review of the topic. RESULTS: TB can no longer be considered a rare disease in the United States because, in part, of the acquired immunodeficiency syndrome epidemic and because, in part, of increased immigration and lack of containment. The signs and symptoms of colonic TB are nonspecific; therefore, a high index of suspicion must be maintained. Only 20 percent of patients will have associated active pulmonary TB. Colonoscopy with multiple biopsies at ulcer margins should be performed for diagnosis. Tissue should be sent for routine histology and culture and smeared for direct visualization of acid-fast bacilli. If colonic TB is suspected, empiric treatment is warranted, despite negative histology, smear, and culture results. Patients will usually show a dramatic response in one to two weeks. Treatment is solely medical, and all patients should receive a full course of antituberculous chemotherapy. Exploratory laparotomy is necessary if diagnosis is in doubt, when there is concern about a neoplasm, or for complications including perforation, obstruction, hemorrhage, or fistulization. CONCLUSION: An increased awareness of intestinal TB coupled with familiarity of the pathophysiology, diagnostic methods, and treatment should increase the number of cases correctly diagnosed preoperatively and, therefore, improve the outcome of patients with this disease.

Aged↗
PubMed1996

Tuberculous colitis. Findings at double-contrast barium enema examination.

PURPOSE: This study was undertaken to elucidate characteristic findings of tuberculous (TB) colitis at double-contrast barium enema examination (DCBE). MATERIALS AND METHODS: Twenty-five patients with TB colitis diagnosed by biopsy (n = 13) or therapeutic trial (n = 12) were included. DCBE findings were retrospectively analyzed, with special emphasis on distribution of lesions and mucosal changes. RESULTS: Involvement was asymmetric in 12. The lesion was noted more commonly in the ascending colon (n = 23), cecum (n = 21), and terminal ileum (n = 19) compared with the transverse colon (n = 15) and descending and sigmoid colon (n = 9). Skipped lesions were seen in 13 patients. Sixteen patients had multiple ulcers that were mostly transverse or circumferential in alignment (n = 11). Depth of ulcers was superficial (< 2 mm) in 9 patients and deep in 13. Two patients had fistulas. Twelve patients had inflammatory polyposis. Three patients presented with mass, and misdiagnosis of malignant tumor was made in two. Thickening, deformity, and incompetence of the ileocecal valve were frequently noted (5, 6, and 8, respectively). CONCLUSION: DCBE revealed detailed mucosal changes of TB colitis. Ulcers aligned in transverse or circumferential pattern, involvement of the right side colon, and deformity of the ileocecal valve suggest diagnosis of TB colitis.

Adolescent↗
PubMed1996

Diagnosis and outcome of isolated rectal tuberculosis.

PURPOSE: Segmental colonic tuberculosis commonly involves the ascending, transverse, or sigmoid colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. This study describes the clinical presentation, endoscopic features, and outcome of isolated rectal tuberculosis. METHODS: Isolated rectal tuberculosis was defined as focal lesions of the rectum in the absence of radiologically demonstrable lesions in the small and large bowel on barium contrast studies. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic features of tuberculosis in biopsy/ resected material, and response to antitubercular therapy. RESULTS: Eight patients with rectal tuberculosis were seen during a four-year period at our hospital. Hematochezia was the most common presenting feature (88 percent), followed by constitutional symptoms (75 percent) and constipation (37 percent). Rectal examination revealed a tight stricture within 10 cm of the anal verge in seven patients. Barium enema showed stricture of variable length, with focal areas of deep mucosal ulceration and increase in presacral space. Proctoscopic findings were tight stricture (7), nodularity with ulceration (6), and multiple aphthous ulcers (1). Granulomatous infiltration was detected in seven of eight patients in biopsy material obtained at endoscopy (6) or surgery (1). Cessation of hematochezia, resolution of constitutional symptoms, and weight gain were seen in all patients following treatment with antitubercular drugs. CONCLUSION: Our data suggest that tubercular involvement of rectum, although uncommon, is an important cause of rectal strictures in India. Response to antitubercular chemotherapy is uniformly good, and surgery is seldom required in these patients.

Adolescent↗
PubMed1995

Detection of anti-cord factor antibodies in intestinal tuberculosis for its differential diagnosis from Crohn's disease and ulcerative colitis.

We have developed a diagnostic method for pulmonary tuberculosis by detecting antibody to cord factor using enzyme-linked immunosorbent assay (ELISA). This study was to evaluate the usefulness of our method for a diagnosis of intestinal tuberculosis, and especially its ability to differentiate this disease from other inflammatory bowel diseases. Antibodies of the immunoglobulin G class against cord factor (trehalose-6,6'-dimycolate) from 27 patients with intestinal tuberculosis, 16 patients with Crohn's disease (CD), and 27 patients with ulcerative colitis (UC) were tested by ELISA with cord factor purified from Mycobacterium tuberculosis H37Rv as the antigen. Twenty-three of the 27 patients with intestinal tuberculosis (85%) showed elevated values distinct from healthy controls. None of the patients with CD showed an elevation of antibody titers. Of the 27 patients with UC, 26 (96%) did not show any anti-cord factor antibody elevation. We conclude that this method is simple and results are reproducible. The results of our study justify undertaking the detection of anti-cord factor antibodies to diagnose intestinal tuberculosis.

Adult↗
PubMed1999

Perianal disease of tuberculous origin: report of a case and review of the literature.

PURPOSE: A case of anal tuberculosis in an otherwise asymptomatic patient with bleeding anal ulcers is presented. The clinical features of this entity and the problems in differential diagnosis between anal infectious vs. inflammatory diseases are discussed. METHODS: The management and outcome of the case of an adult patient who presented with perianal ulcers is described. RESULTS: On a three-drug antituberculous regimen, symptoms abated, radiographic infiltrates improved, and perianal ulcers healed. CONCLUSION: Anal tuberculosis is an extremely rare disease. A tuberculous origin must be considered when the cause of perianal ulcers is unclear to avoid undesirable delays in the diagnosis and treatment of this disease.

Anus Diseases↗
PubMed2000

Tuberculous anal sepsis: report of clinical features in 20 cases.

INTRODUCTION: Tuberculosis is a neglected cause of anal sepsis, often is not recognized, and therefore is not treated properly. METHOD: All patients were reviewed who had tuberculous anal sepsis diagnosed by histology reports of fistulectomy specimens or abscess scrapings from January 1990 to April 1999. RESULTS: Twenty patients (median age, 53 years; 18 males) with anal tuberculous sepsis were identified. They presented with abscesses (n = 2), abscesses and fistulas (n = 6), or fistulas (n = 12). All patients had a long history of anal complaints (3 months to 20 years), for which 15 patients were operated on previously. Nearly all fistulas (17/18) were complex, and secondary tracks or additional complicating features were common, even at first presentation. Eight patients had active concurrent pulmonary tuberculosis, and six showed evidence of previous pulmonary tuberculosis. Six patients had no signs of concurrent or previous tuberculosis elsewhere. Recurrence was observed only in cases where tuberculosis was initially not recognized, and antitubercular treatment therefore was not started. CONCLUSION: Contrary to views held previously, anal tubercular sepsis seems to have characteristic clinical features. It should be considered in cases of known pulmonary or extrapulmonary tuberculosis or if anal sepsis is persistent, recurrent, or complex in nature.

Adult↗
PubMed1976

Tuberculous esophagitis.

Roentgenographic changes in a case of tuberculosis involving the esophagus were ulceration and narrowing of the esophagus, and sinus tracts to the mediastinum. Disseminated tuberculosis was discovered only at autopsy. The diagnosis of tuberculous esophagitis in a patient with no other demonstrable tuberculous lesions is difficult, as clinical and roentgenographic findings are not specific.

Aged↗
PubMed1976

Intestinal tuberculosis.

Intestinal tuberculosis is a disease with protective clinical manifestations. The radiographic changes in the bowel are similarly varied but often highly suggestive if not characteristic. The key radiologic changes in the bowel, with emphasis on the ileocecal area, are described and the clinical and pathologic features are reviewed.

Aged↗
PubMed1978

Angiography in the diagnosis of ileocecal tuberculosis.

Ileocecal tuberculosis is still found sporadically in industrialised countries and occurs commonly in the underdeveloped world. Differentiation from Crohn's disease is a major diagnostic problem on which rational treatment depends. An angiographic appearance demonstrated in two patients is believed to be a useful diagnostic indicator of tuberculous etiology.

Angiography↗
PubMed1995

Colonic and peritoneal tuberculosis associated with coloduodenal fistula.

We report a very rare case of tuberculous colitis that showed relatively long-segment involvement of the colon near the hepatic flexure with coloduodenal fistula that caused severe malnutrition. The formation of fistula in abdominal tuberculosis is very rare. This is the eighth reported case of abdominal tuberculosis with fistula and the first reported case with a coloduodenal fistula.

Adult↗
PubMed1991

Generalized peritonitis in India--the tropical spectrum.

Generalized peritonitis is a common surgical emergency in India, the 'Tropical Spectrum' of generalized peritonitis being different from the western spectrum. A total 155 cases of generalized peritonitis were surgically treated at the All India Institute of Medical Sciences between 1981 and 1987, all patients undergoing peritoneal toilet with drainage after the cause of their peritonitis had been treated. The most common cause of peritonitis was peptic ulcer perforation, with simple closure being associated with a 2 per cent mortality, while typhoid perforation was the second most common cause. The diagnosis was clinical, supported by the operative findings of a terminal ileal perforation while bacteriological, serological and histopathological confirmation was retrospective. Appendicular perforations were less common than in the west but the clinical picture was the same. Tubercular perforations were not uncommon with a previous history of subacute intestinal obstruction and evidence of tuberculosis on chest X-ray suggesting the diagnosis. Ruptured amebic liver abscess was the most common hepatobiliary cause of generalized peritonitis with drainage of the abscess producing good results. The average hospital stay was 15 days with an overall mortality of 8 per cent.

Adult↗
PubMed1984

Tuberculosis presenting as inflammatory bowel disease. Report of two cases.

Two cases are reported of idiopathic inflammatory total colitis in patients with a previous history of tuberculosis. One showed colonoscopic and radiologic features of Crohn's disease and the other was diagnosed as ulcerative colitis. Tuberculous organisms were identified in the mesenteric nodes in one patient, but were not detected in the other. Both patients improved with antituberculous treatment. This report emphasizes the importance of considering tuberculosis in patients presenting with idiopathic inflammatory bowel disease of the colon and raises speculation of the possible infective etiology of Crohn's disease.

Adolescent↗