Tuberculosis abdominal: patología infrecuente en un paciente joven: reporte de un caso / Abdominal tuberculosis: an unusual disease in a young patient: a case report

Resumen Introducción: La tuberculosis abdominal es un problema reemergente, y es una de las enfermedades transmisibles más importante en todo el mundo. A pesar de las expectativas acerca de su erradicación en países en desarrollo, ha sido recientemente declarada de nuevo como una patología de emergencia mundial. Con el aumento de su incidencia y prevalencia, su forma abdominal es una de las presentaciones de afectación extrapulmonar más comunes. Objetivo: Dado que la tuberculosis puede afectar diversos órganos, tiene una amplia gama y gran espectro de signos y síntomas que dificultan su diagnóstico y retrasan el tratamiento. Por esto, se realiza esta revisión de tema, concentrándonos en que el alto índice de sospecha debe ser un factor importante en el diagnóstico precoz, para que una vez establecido, se pueda iniciar el tratamiento ayudando a prevenir y disminuir las altas tasas de morbilidad y mortalidad evidenciadas en la actualidad. Caso Clínico: Paciente joven con presencia de ascitis secundaria a tuberculosis abdominal confirmada por una biopsia y el aumento de la adenosin deaminasa en el líquido peritoneal. Se describen los principales hallazgos clínicos, paraclínicos, estudios imagenológicos y tratamiento.

Introduction: Abdominal tuberculosis is a reemerging problem and is one of the most important communicable diseases in the world. Despite expectations about the eradication in developing countries, it has recently been re-declared as a global emergency pathology. The increased incidence and prevalence shows an abdominal shape as one of the most common extrapulmonary involvement presentations. Objective: Since tuberculosis can affect various organs, it has a wide range and spectrum of signs and symptoms that make diagnosis difficult and delay treatment. Therefore, this review of the topic is done, concentrating on the fact that the high suspicion index should be an important factor in the early diagnosis. Treatment can be initiated helping to prevent and reduce high morbidity and mortality rates. Case Report: We present a case of a young patient with ascites secondary to abdominal tuberculosis confirmed by biopsy and increased adenosine deaminase in the peritoneal fluid. The main clinical findings, paraclinic, imaging studies and treatment are described.

Tuberculosis colónica. Presentación de caso / Colonic tuberculosis. Report of a case

Introducción: la tuberculosis es una enfermedad conocida desde la antigüedad, causada por el Mycobacterium Tuberculosis. En las últimas décadas hubo un resurgimiento de la patología, debido a la infección por HIV. La tuberculosis gastrointestinal representa del 3 al 5% de todos los casos de localización extrapulmonar. Objetivo: evaluar el comportamiento de una patología infrecuente del colon, a partir de un caso clínico. Material y método: paciente masculino de 50 años, operado, con diagnóstico anatomopatológico de tuberculosis colónica. Resultados: se realizó colectomía derecha, por hemorragia digestiva baja grave. Conclusiones: es una entidad poco frecuente, que raramente involucra el colon. El compromiso gastrointestinal es la sexta forma más frecuente de tuberculosis extrapulmonar. La región ileocecal, es la que se encuentra mas afectada. El tratamiento es médico, la cirugía se reserva para las complicaciones de la entidad.

Background: tuberculosis is a disease known since antiquity, caused by Mycobacterium tuberculosis. In recent decades there has been a resurgence of the disease due to HIV infection. The gastrointestinal tuberculosis represents 3 to 5% of extrapulmonary cases. Purpose: to evaluate the behavior of a rare pathology of the colon, from a clinical case. Material and Methods: male patient, 50 years old, diagnosed with colonic tuberculosis, who underwent surgery. Results: right colectomy for severe low gastrointestinal bleeding. Conclusions: it is a rare entity, which rarely involves the colon. The gastrointestinal involvement is the sixth most common form of extrapulmonary tuberculosis. The ileocecal region, is the most affected. The treatment is medical, with surgery reserved for complications of the entity.

Tuberculosis of the Duodenum: Clinical presentation, diagnosis and outcome.

Buck&round: Duodenal tuberculosis accounts for <2% of abdominal tuberculosis and usually manifests with recurrent vomiting. Existing guidelines suggest surgery as the mainstay for both obtaining a definitive diagnosis as well as for therapy. Aims: The aim of this prospective study was to describe the clinical presentation and usefulness of endoscopic techniques in the diagnosis and treatment of duodenal tuberculosis. Methods: Data of patients diagnosed to have duodenal tuberculosis over a three-year-period were analysed for age, presenting symptoms and outcome of therapy. Diagnosis was based on histological evidence of granulomatous inflammation along with unequivocal improvement in vomiting and other symptoms over six-eight weeks following a combination of anti-tubercular drug therapy and endoscopic balloon dilatation. Results: Ten patients with recurrent vomiting (median age 27 years) were diagnosed to have duodenal tuberculosis. Significant narrowing was seen at endoscopy in nine patients with post bulbar area being the commonest site in five patients. Histological diagnosis of granulomatous duodenitis was possible in nine (90%) patients. Balloon dilatation achieved resumption of normal diet at a median duration of seven days (range 2-40). Symptomatic improvement was substantiated by a median increase in BMI of 5 kg/m2 over the baseline value. Surgical intervention was not required in any patient. Conclusions : Recurrent vomiting due to gastric outlet obstruction is the commonest presentation of duodenal tuberculosis. Endoscopically, a histological diagnosis of granulomatous inflammation can be achieved in most of the patients. Endoscopic balloon dilatation coupled with anti-tubercular drug therapy is safe and effective treatment for this uncommon disease.

Tuberculose intestinal de localização colônica simulando neoplasia: relato de caso / Intestinal tuberculosis in colonic location mimicking neoplasia: case report

Objetivos: relatar um caso de tuberculose intestinal e enfatizar a necessidade e a dificuldade do diagnóstico diferencialcom neoplasia de cólon.Descrição do caso: uma paciente feminina de 52 anos teve uma lesão colônica diagnosticada por colonoscopiae biópsia, sugerindo adenocarcinoma. Foi realizado tratamento cirúrgico e o diagnóstico final foi de tuberculoseintestinal. A paciente era imunocompetente, tendo sido indicado tratamento com tuberculostáticos.Conclusões: achados endoscópicos e histopatológicos pré-operatórios devem ser interpretados cuidadosamente esempre correlacionados com o contexto clínico. O diagnóstico diferencial das lesões colônicas deve incluir neoplasiasmalignas e outras possíveis etiologias, como a tuberculose extrapulmonar.

Aims: To report a case of intestinal tuberculosis and emphasize the necessity and difficulty of differential diagnosiswith colonic cancer.Case description: A female patient of 52 years had a colonic lesion diagnosed by colonoscopy and biopsy, suggestingadenocarcinoma. Surgical treatment was performed and the final diagnosis was intestinal tuberculosis. The patientwas immunocompetent, and tuberculostatic treatment was indicated.Conclusions: Endoscopic and histological preoperative must be interpreted cautiously and always correlated with theclinical context. The differential diagnosis of colonic lesions should include malignant neoplasms and other possibleetiologies, such as extra-pulmonary tuberculosis.

Role of surgery and laparoscopy in management of abdominal tuberculosis

Tuberculosis [TB] considered as the most communicable disease world wid. Among extra pulmonary TB the prevalence of abdominal TB shows rising tendency. Abdominal TB is defined as an infection of one or more common of two or more of the following sites; peritoneum, mesentery, gastrointestinal tract and or solid organs. Reported incidence of abdominal TB varies from country to country. The most common clinical features are abdominal pain, fever and weight loss. To evaluate the role of surgery in the management of abdominal TB especially with the advent of minimal access surgery [laparoscopy] in the diagnosis of this disease. Prospective study was conducted in Al-Kadhymia Teaching Hospital over three years [2007-2010], fifty six patients with abdominal TB were included, the patients were managed by full surgical and or medical teams, results was analyzed by appropriate statistical measures. Most patients were in the 2[nd], 3[rd] and 4[th] decades of life. Female to male ratio was 1.5:1. Most of the patients [82%] considered to have primary abdominal TB. Diagnostic laparoscopy was done for 21 patients and proved TB in 19 patients. Explorative laparotomy was done in 19 patients, the commonest operative finding was ascites and peritoneal tubercles. Abdominal TB should be considered in all patients who presented with unexplained abdominal symptoms and signs. Laparoscopy is an effective modality for diagnosis of abdominal TB

Úlcera tuberculosa intestinal como causa de hemorragia digestiva baja masiva exanguinante / Intestinal tuberculosis causing a severe gastrointestinal bleeding: report of one case

We report a 27 years old woman presenting with hematochezia. An upper endoscopy and colonoscopy did not reveal the bleeding site. Due to persistence of bleeding, the patient was operated, finding a fibrinous secretion surrounding bowel loops and a hyper vascularized concentric papular lesion. The involved bowel loop was excised. The pathological study of the surgical piece revealed intestinal tuberculosis. The patient started treatment for extra pulmonary tuberculosis.

Reportamos el caso de una paciente de 27 años con tuberculosis extrapulmonar gastrointestinal que se manifestó clínicamente como una hemorragia digestiva baja masiva exanguinante requiriendo cirugía de urgencia, donde se realizó laparotomía exploradora con entero y colonoscopía intraoperatoria localizando lesión a nivel de intestino delgado, resecando segmento comprometido con anastomosis primaria, evolución satisfactoria sin complicaciones postoperatorias.

unique variant of intestinal tuberculosis

Duodenum is a rare site of involvement in intestinal tuberculosis. We report a 19 years old boy who presented with non-bilious vomiting and weight loss. His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan. Upper GI endoscopy revealed stricture in 2[nd] part of duodenum distally. He was operated and duodenojejunostomy with limited right hemicolectomy [for stricture in this part of gut] were done. Biopsy report was suggestive of tuberculosis. Antituberculous treatment was started. He responded well and gained 20 kg weight at 3 months follow-up

Hypertrophic pyloroduodenal tuberculosis

Hypertrophic pyloroduodenal tuberculosis is a rare cause of Gastric Outlet Obstruction [GOO] often forgotten in the differential diagnosis of gastric outlet obstruction. Since laboratory and radiological investigations often prove inconclusive in reaching the diagnosis of hypertrophic pyloroduodenal tuberculosis, surgery has a key role in the management of hypertrophic pyloroduodenal tuberculosis. Postoperative anti-tuberculosis chemotherapy [ATT] becomes imperative for complete resolution of hypertrophic pyloroduodenal tuberculosis. This case report describes the condition and management in a young girl

study of 86 cases of abdominal tuberculosis

The aim of this study was to evaluate the varied presentation, morbidity/ mortality and outcome of various surgical procedures done in patients with abdominal tuberculosis. Case Series. Surgical Unit III and IV Bolan Medical College Complex Hospital Quetta, from January 2005 to June 2007. All those patients who were clinically suspected to have abdominal tuberculosis, supported by investigation and gross morphological findings at surgery and histopathologically proven caseating granulomas were included in this study. A total of 86 patients were managed during the study period. The mean age of patients was 35.6 years and male to female ratio of 1:2. Primary intestinal tuberculosis was found in 78%. About 52.3% of patients had single or multiple strictures involving the distal ileum and ileocaecal region. 27.9% of patient had mass in the ileocaecal region. Perforation was recorded in 19.8% cases. Mortality was 2.3%. Major postoperative complications occurred in 13.9% of patients. All patients were prescribed anti tuberculosis drugs for a period of 12 months. The median follow up was 6 month. 82.5% of patients were doing well till the last visit. Patients who present with bowel obstruction especially sub acute or chronic, should have a complete workup to prove or rule out intestinal tuberculosis. In the presence of bowel perforation with faecal peritonitis and intra-abdominal sepsis, ileostomy is a safer procedure than primary anastomosis

Abdominal tuberculosis;Still the great mimicker

To study the different clinical presentations, operative and postoperative course of abdominal tuberculosis. Case series study. Surgical units, Bahawal Vicotria Hospital, Bahawalpur. May 01, 2005 to April 30, 2007. This was a prospective type of case series study. A selection criterion of patients was that all patients of either sex and age being diagnosed as case of abdominal tuberculosis. The clinical record of the patient's data, symptoms and signs, biopsy report, biochemical and radiological report, treatment [surgery and chemotherapy] given and a follow-up. Total 96 patients presented with abdominal tuberculosis, 60[62.5%] were male and 36[37.5%] were female. Peritonitis was present in 48[50%] patients, intestinal obstruction[acute and sub-acute] was present in 32[33.33%] patients, mass right iliac fossa was present in 14[14.58%] patients and 2[2.08%] patient presented with mass in the epigastrium. 28[29.16%] patients has concurrent pulmonary tuberculosis. Two patients expired so mortality rate was 2.08%. The control of TB has been a challenging problem because the natural history of the disease and its varying pattern in which it manifests is in different groups

Abdominal tuberculosis: Clinical presentation and outcome

To study the clinical presentation and outcome of cases of Abdominal Tuberculosis. Prospective cross-sectional study from January 2005 to December 2006. Surgical Unit II and V, Civil Hospital, Karachi. Fifty four patients of Abdominal Tuberculosis were seen during the study period Four patients were lost to follow-up, which were excluded. Detailed information of all the patients including age, sex, symptoms, signs, investigations and management was recorded, analyzed and compared with local and international data. Out of the 50 patients with Abdominal Tuberculosis, 31 were females and 19 males. Their ages ranged from 17 to 63 years, with a mean age 425.1 years. Thirty five cases were admitted through Emergency and 15 through Outpatients departments. Abdominal pain was the most common symptom found in 44 [88%] patients followed by vomiting in 33 [66%]. Abdominal tenderness was seen in 22 [44%] patients, while 16 [32%] patients had rigidity and other features of peritonitis. Surgery was performed in all these patients, limited right hemicolectomy in 17 [34%], segmental resection and anastomosis in 12 [24%], ileostomy and strictureplasty in six [12%] each, repair of perforation in five [10%] and adhesiolysis in four [8%] patients. Overall mortality was 8% due to septicaemia and multiorgan Abdominal Tuberculosis is a significant clinical entity with lethal complications in neglected cases. It affects a younger age group and is more common in females. Clinical features are rather non-specific but vague ill health, low grade fever, weight loss and anorexia may help to diagnose the case

Clinicopathological profile and surgical management outcomes in patients suffering from intestinal tuberculosis

To determine the mode of presentation in intestinal tuberculosis and effectiveness of various surgical procedures adopted in our set up. A descriptive study. Liaquat University Hospital, Hyderabad from June 1996 to May 1998 and Muhammad Medical College Hospital Mirpurkhas, Sindh from April 2002 to March 2004. One hundred-twelve cases of intestinal tuberculosis were studied, which were operated and diagnosis was confirmed on biopsy. Data collection included detailed history particularly duration of symptoms, respiratory complains, dietary habits and bowel habits. At Liaquat University Hospital, 1872 patients were admitted, 386 [20.61%] were operated for abdominal complains [acute, sub-acute or chronic intestinal obstruction or perforation] and 80 [4.27%] were diagnosed as having intestinal tuberculosis. Meanwhile, 624 patients were admitted in Muhammad Medical College Hospital Mirpurkhas. Of these, one hundred-seventy [27.24%] were operated for abdominal pathology and 32 [5.12%] cases were proved as intestinal tuberculosis on histopathology. Out of total 112 cases of intestinal tuberculosis, 64 [57.20%] were male and 48 [42.80%] females. Age ranged from 8 to 55 years with majority in 2nd and 3rd decades. Resection and anastomosis of small gut, limited right hemicolectomy, right hemicolectomy, stricturoplasty, ileostomy, adhenolysis and evacuation of pus were the procedures adopted for management. Post-operative complications were seen in 30.65% of patients with wound infection on top, however, mortality remained 3.57%. The mortality of intestinal tuberculosis is high due to delay in diagnosis and under dosage or irregular anti-tuberculous treatment. In complicated cases, surgery is indicated. When multiple strictures or perforations are present, resection and end to end anastomosis is required. In case of caecal mass [fungating type], right hemicolectomy can be performed and in cases where extensive adhesions are present and there is fear of iatrogenic perforation, in attempts to mobilize right colon, limited right hemicolectomy shall be performed

Surgical management of obstructive gastroduodenal tuberculosis.

BACKGROUND: Gastroduodenal tuberculosis is a rare but potentially curable condition. The aim of the present study was to evaluate the clinical presentation, pre-operative status, management and outcome in patients with histologically proven diagnosis of gastroduodenal obstruction due to tuberculosis. METHODS: We retrospectively reviewed the records of 17 patients managed surgically for gastroduodenal obstruction due to tuberculosis. RESULTS: The site of obstruction was the pyloroduodenal canal in 53% of patients, second part of the duodenum in 24%, third part of the duodenum in 12% and duodenjojejunal flexure in 12%. The obstruction was caused by fibrotic stricture formation in 59% of patients and extrinsic compression by a lymph nodal mass in 41%. Endoscopic biopsy was diagnostic in only 29% of the patients in whom it was performed. Overall, a pre-operative diagnosis of gastroduodenal tuberculosis was suspected in only 35% of patients. All the patients underwent surgical drainage procedures and the diagnosis was confirmed by histopathological examination of biopsies taken at the time of laparotomy. CONCLUSIONS: In view of its rarity and non-specific findings on clinical, radiological and endoscopic evaluation, tuberculosis as a cause of gastroduodenal obstruction is seldom diagnosed pre-operatively. Hence, a high index of suspicion is required in young patients residing in endemic areas. Surgical intervention helps not only in relieving obstruction but also in confirming the diagnosis.

Comparison between stricture plasty and resection anastomosis in tuberculous intestinal strictures

To compare the effectiveness, safety and morbidity of strictureplasty with resection anastomosis in patients with tuberculous small gut strictures. Design: Prospective comparison study. Place and Duration of Study: Surgical Unit-I of Rawalpindi General Hospital from March 2000 to February 2002. Patients and Thirty patients who presented with intestinal obstruction due to tuberculous strictures, and underwent either resection anastomosis or strictureplasty were included in the study. Data was collected on a proforma and analyzed using software SPSS [version 8.0]. Chi-square and t-test were used to test the hypothesis. Main outcome measures included the presence or absence of postoperative leakage anastomosis, wound infection, recurrence of intestinal obstruction and postoperative stay. Chi-square test applied to see the effectiveness showed no significant difference [p>0.5] between the two procedures. t-Test on the score of morbidity also showed no significant difference [p>0.5] between the two procedures. Both procedures performed were equally effective and had equal morbidity in cases of intestinal tuberculous strictures. Strictureplasty is superior to resection anastomosis in cases of multiple strictures as it conserves gut length and can even be performed safely in cases with coexistent gut perforation

Tuberculose entérica / Intestinal tuberculosis

The authors reports two patients with operated from enteric tuberculosis. Tuberculosis involving the intestinal tract may be due to either Mycobacterium tuberculosis or M. bovis. In the former situation, the disease is primary to the lungs and is carried to the intestinal tract by swallowing sputum. The latter organism produces infection associated with swallowed nonpasteurized milk. This condition is extremely unusual in most western countries, since pasteurization of milk is standardized. The diagnosis was performed through laparotomy because of symptoms suggestive of intestine obstruction. Inflammatory reactions were observed on the small intestine (jejunum-ileum) in both cases. The presence of tuberculosis of the lungs was observed in one patient. The chemotherapic treatment was estabilished after the histopathologic diagnosis. The distinction between tuberculosis and Crohn's disease may not be possible by radiography or endoscopy. Videolaparoscopy has been found to be an useful procedure for the early diagnosis of Enteric Tuberculosis. In spite of the epidemiology knowledge, clinical control and improvement in treatment, extra pulmonary tuberculosis rate from concealed focus has been increased, due to AIDS poverty in certain populational groups and immigration from Asia to wertern countries. Compared with immunocompetent patients, the proportion of extrapulmonary tuberculosis is much higher in patients with AIDS, justfying the increased frequency of reports of intestinal tuberculosis in these patients

Toxic amebic colitis coexisting with intestinal tuberculosis

A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation. Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen. Subtotal colectomy including segmental resection of ileum, about 80 cm in length, followed by exteriorization of both ends, was performed in an emergency basis. Despite all measures, the patient died on the sixth postoperative day. The exact relationship of fulminant amebic colitis and intestinal tuberculosis is speculative but the possibility of a cause and effect relationship exists. Fulminant amebic colitis may readily be confused with other types of inflammatory bowel disease, such as idiopathic ulcerative colitis, Crohn's disease, perforated diverticulitis and appendicitis with perforation. This report draws attention to the resurgence of tuberculosis and amebiasis in Korea, and the need for the high degree of caution required to detect it.

Inguinal hernia incarceration as a form of intestinal tuberculosis

We report the case of a 41 year-old male who came to the emergency room with a complaint of abdominal pain, and was diagnosed to have an acute obstructive abdomen due to a right inguinal hernia incarceration. During surgery, an intestinal granulomatous inflammation was observed adhered to the hernial sac. The histopathologic study confirmed the diagnosis of tuberculosis. We present a review of the different clinical forms of intestinal tuberculosis and the difficulties encounted in the differential diagnosis of such, emphasizing the uncommon presentation described in our patient.