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PubMed1999

Abdominal tuberculosis: the problem of diagnostic delay.

Abdominal tuberculosis can be difficult to diagnose. In order to minimize diagnostic delay, an audit study showed that the Mantoux test and/or culture of ascitic fluid did not reveal tuberculosis immediately. Laparoscopy/laparotomy with Ziel-Nielson staining and culture of tissue biopsy always confirmed the diagnosis. It is suggested that biopsy should be the first line in investigating patients suspected of having abdominal tuberculosis.

Adult↗
PubMed2003

Imaging of esophageal tuberculosis: a review of 23 cases.

PURPOSE: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. MATERIAL AND METHODS: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. RESULTS: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

Adult↗
PubMed1980

A study of malabsorption in intestinal tuberculosis: stagnant loop syndrome.

A study was carried out in the patients with intestinal tuberculosis and obstruction requiring surgery to determine the pathogenesis of malabsorption in this condition. Fifteen of the 20 patients studied had malabsorption, nine of 17 (53%) had intestinal bacterial overgrowth and 10 of 16 (62.6%) had free bile acids in their jejunal aspirates. In a comparable group of nontuberculus intestinal obstruction requiring surgery, six of seven (85.7%) had malabsorption, and four of five (80%) had both the bacterial overgrowth as well as bile salt deconjugation. Among a group of 10 patients with intestinal tuberculosis without significant obstruction, four were found to have malabsorption but only one had evidence of bacterial overgrowth and bile salt deconjugation. In contrast, only one of the 10 patients with extraintestinal tuberculosis and none of the 12 healthy, normal subjects had malabsorption. None had bacterial overgrowth or bile salt deconjugation in either group. Resection of the obstructing lesion corrected the malabsorption as well as the bacterial overgrowth and the bile salt deconjugation in all four patients tested with intestinal tuberculosis. Malabsorption in intestinal tuberculosis thus appears to be associated with obstruction rather than with the tuberculous process. Demonstration of bacterial overgrowth and bile salt deconjugation in the upper small intestine of patients with intestinal tuberculosis with obstruction and malabsorption indicate the presence of a stagnant loop syndrome.

Adolescent↗
PubMed2000

Abdominal tuberculosis in children: an Indian experience.

The hospital records of 125 children, aged 14 years or less treated for abdominal tuberculosis (TB) at Jawahar Lal Nehru Medical College and Hospital, Ajmer, India between January 1987 and December 1996, were studied to analyse the various patterns of abdominal TB in children and to evaluate the role of various investigations in researching a diagnosis. Abdominal pain was the presenting symptom in 100 (80 per cent) patients. Detectable ascites was present in 55 (44 per cent) and visible peristalsis in 45 (36 per cent) cases. Laboratory investigations and radiographs were not conclusive in the majority of the patients. In 45 (36 per cent) patients in whom no tissue diagnosis was available, the diagnosis was based on a dramatic clinical response to anti-tuberculous chemotherapy. Fifty (40 per cent) patients were treated conservatively with anti-tuberculous drugs alone; the remaining patients underwent laparotomy for diagnosis and relief of bowel obstruction. There were no post-operative deaths and on follow-up, good recovery was observed in these patients. Abdominal TB in children is of a non-specific nature and defies diagnosis with non-invasive investigations; laparotomy is required for a definitive diagnosis in the majority of the patients. However, if a high index of suspicion is maintained in endemic areas, a therapeutic trial of anti-tuberculous chemotherapy is justified.

Abdominal Pain↗
PubMed1995

Prominent small bowel Ga-67 uptake associated with Yersinial and tuberculous enterocolitis.

The nuclear medicine evaluation of the immunocompromised patient with fever of unknown origin may include the use of either labeled leukocytes or Ga-67 citrate, or both, in the search for an infectious focus. In recent years, labeled leukocytes (In-111 or Tc-99m) seem to have been employed preferentially by some. This is especially the case when the abdomen is a suspected site of involvement because of the normal colonic excretion of gallium that may complicate the interpretation of this study. The authors present the case of an immunocompromised patient with the interesting scintigraphic pattern of diffuse large and small bowel uptake of gallium secondary to biopsy proven Yersinia and tuberculous enterocolitis. A review of the recent literature reveals only one other similar case in which Yersinial disease was detected by Ga-67 scintigraphy. The present case illustrates that gallium's avidity for the atypical, less pyogenic, opportunistic infections common in immunocompromised patients justifies its continued use in such settings and, specifically, whenever tuberculosis is suspected.

Adult↗
PubMed1988

The role of colonoscopy in the diagnosis of tuberculosis.

The value of colonoscopy in the diagnosis of ileocolonic tuberculosis at Groote Schuur Hospital was assessed and the published world experience reviewed. During a 4-year period, abdominal tuberculosis was diagnosed in 94 patients, of whom 18 manifested involvement of the ileocecal area and/or colon. Colonoscopy, performed in 10 of these, provided diagnostic information in 7. Since the endoscopic appearance of diseased mucosa is nonspecific, adequate bacteriological and histological assessment of biopsied tissue is essential to differentiate tuberculosis from other disorders that may simulate it. We stress the importance of microscopy and culture for Mycobacterium tuberculosis.

Adult↗
PubMed1992

Diseases of the intestine mimicking Crohn's disease.

We describe five patients who were initially thought to have Crohn's disease and were treated accordingly. The original diagnosis was based upon clinical presentation, roentgenograms, and histological examination, but subsequent follow-up showed that diagnosis to be in error. The following diagnoses were established instead: tuberculosis, Actinomyces Israeli infection, reaction to gold therapy, metastatic cancer, and linitis plastica. We stress the importance of considering conditions that can mimic Crohn's disease.

Actinomycosis↗
PubMed1981

Unusual inflammatory processes involving the colon.

Six patients with unusual inflammatory lesions of the colon are presented. Several of these cases demonstrated unusual presentations of an unusual disease. The clinical and radiologic features (which together are of paramount importance in suggesting the correct diagnosis) are discussed. Important differential diagnostic considerations are listed.

Actinomycosis↗
PubMed1997

Colonic tuberculosis and adenocarcinoma: an unusual presentation.

A case is presented of caecal tuberculosis coexisting with adenocarcinoma at the same site, unusually presenting as a right iliac fossa abscess. The relevant literature on 61 previously reported patients with coexisting tuberculosis and colonic carcinoma is reviewed. The patient was 81-years-old, female with a tender swelling in the right iliac fossa. Following examination by ultrasound, laparotomy was undertaken which revealed a large abscess cavity contaminated by Mycobacterium tuberculosis. Although anti-tuberculosis treatment was given, there was a persistent purulent discharge from the wound, so a new ultrasound, computed tomography scan and barium enema were arranged. These could not clearly differentiate between ileocaecal tuberculosis and carcinoma. A second laparotomy showed that there was an underlying adenocarcinoma. Although rare, the coexistence of colonic tuberculosis with carcinoma should be seriously considered especially in patients who fail to respond to anti-tuberculosis treatment. A definitive diagnosis can be established only by histological examination.

Adenocarcinoma↗
PubMed2005

A solitary tuberculous ulcer in the oesophagus.

A 48-year-old woman born in Pakistan was evaluated for dysphagia. Endoscopy showed a solitary ulcerative oesophageal lesion. Cultures were positive for mycobacterium tuberculosis. Additional imaging showed no other manifestations of tuberculosis. Oesophageal tuberculosis is a rare entity, especially as a primary manifestation defined as involvement of the oesophagus without signs of disseminated disease. Therefore, this case was classified as primary oesophageal tuberculosis.

Diverticulum, Esophageal↗
PubMed2005

Abdominal tuberculosis in Bradford, UK: 1992-2002.

INTRODUCTION: Bradford, in West Yorkshire, United Kingdom, has a population of 486 340 of which 17.3% originate from South Asia. We describe our experience of abdominal tuberculosis over a 10 year period. METHODS: Fifty-nine cases of abdominal tuberculosis were identified between 1992 and 2002 from the Tuberculosis Registry, Bradford hospitals. Fifty case records were available for retrospective review. RESULTS: Median age of the patients was 38 years (range, 14-81) and 35 (59.3%) were females. Fifty-four (91.5%) patients were of South Asian origin, four (6.8%) were Caucasians and one patient was an Arab. The mean standardized incidence of abdominal tuberculosis in the South Asian population during the study period was 9.32 cases/10(5)/year whereas in the local white population it was 0.1/10(5)/year (relative risk=93). Fever (90%), abdominal pain (88%) and weight loss (82%) were the commonest presenting features. Ileocaecal region in 20 (40%) patients and tubercular peritonitis in 16 (32%) cases were the common sites involved. Active pulmonary tuberculosis was present in 18 (36%) patients. Diagnosis of tuberculosis was confirmed by isolating acid-fast bacilli or by demonstrating caseating granulomas on biopsy in 36 (72%) cases. Acid-fast bacilli isolated in all the 29 (58%) cases were Mycobacterium tuberculosis and were sensitive to all standard anti-tubercular drugs except one patient who was resistant to isoniazid. CONCLUSION: Abdominal tuberculosis remains a common problem in a multicultural community in the United Kingdom with a varied presentation. High index of suspicion is required for early diagnosis. Most of the patients respond very well to standard anti-tubercular therapy and surgery is required only in a minority of cases. Drug resistant abdominal tuberculosis has not been a problem in this series.

Abdomen↗