Consideraciones diagnósticas y terapéuticas de la tuberculosis intestinal / Diagnostic and Therapeutic Considerations about Abdominal Tuberculosis

Introducción: La tuberculosis es una enfermedad reemergente, importante como causa mayor de incapacidad y muerte en muchas zonas del mundo. La tuberculosis intestinal representa 11 por ciento de todas las formas extrapulmonares; 0,5 por ciento de todos los casos nuevos de y el 10 al 15 por ciento en los no infectados por el VIH. En el municipio Tunas se notificó el caso de un adolescente de 17 años, masculino, al que se le diagnostica esta enfermedad luego de haber presentado síntomas de dolor abdominal recurrente durante de varios meses antes del diagnóstico. Objetivo: Actualizar la información sobre el diagnóstico y tratamiento de la tuberculosis intestinal. Métodos: Se realizó una revisión bibliográfica sobre tuberculosis intestinal con la literatura encontrada en bases de datos disponibles en la red Infomed: PubMed, Hinari, The Cochrane Library, SciELO, MEDLINE y MedicLatina; con un enfoque histórico-lógico y de análisis-síntesis. Conclusiones: El diagnóstico precoz de la tuberculosis intestinal sin tuberculosis pulmonar activa continúa siendo un problema de salud, ya que los parámetros clínicos, bioquímicos, imagenológicos y endoscópicos aún carecen de especificidad, y en algunos casos se ha mostrado resistencia al tratamiento habitual(AU)

Introduction: Tuberculosis is a reemerging disease, also important as a major cause of disability and death in many regions of the world. Abdominal tuberculosis represents 11 percent of all extrapulmonary forms; 0.5 percent of all new cases of HIV infection and 10-15 percent of those not infected with HIV. In Las Tunas Municipality, the case of a 17-year-old male adolescent who was diagnosed with this disease was reported after the patient presented symptoms of recurrent abdominal pain for several months before diagnosis. Objective: To update information on the diagnosis and treatment of abdominal tuberculosis. Methods: A literature review on intestinal tuberculosis was carried out with the literature found in databases available on the Infomed network, such as PubMed, Hinari, The Cochrane Library, SciELO, MEDLINE, and MedicLatina, with a historical-logical and analysis-synthesis approach. Conclusions: The early diagnosis of intestinal tuberculosis without active pulmonary tuberculosis continues to be a health concern, since clinical, biochemical, imaging, and endoscopic parameters still lack specificity, and, in some cases, resistance to usual treatment has been shown(AU)

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.

frequency and management of intestinal Tuberculosis; a hospital based study

To determine the frequency of clinical manifestation of intestinal tuberculosis and outcome of different treatment modalities. This descriptive study was conducted at Lady Reading Hospital Peshawar from July 2005 to June 2006. Fifty cases having radiological evidence of tuberculosis in the intestines were included in the study. Various parameters like age, sex, presentation, investigation and various treatment modalities were studied. Twenty three [46%] patients presented with subacute and 13 [26%] with acute intestinal obstruction and 12 [24%] with signs of peritonism. Presenting symptoms were: pain abdomen and anorexia in 47[94%] patients, nausea / vomiting in 30 [60%] patients and constipation in 28 [56%] patients. Tenderness was present in 48 [96%] patients and distension of abdomen in 35 [70%]. Two [4%] patients were treated conservatively and 48 patients [96%] were managed by surgery [emergency surgery 34 cases, semi-elective surgery 14 cases]. In 47 [94%] patients, diagnosis was confirmed by characteristic caseating granuloma. Resection of the small bowel with ileo-ileal anastamosis was done in 16 cases and limited right hemicolectomy with ileo-colic anastamosis in 14 cases. Two staged procedures were performed in 8 cases. Only three [6%] cases needed re-admission for complications, two [4%] for sub-acute obstruction and one [2%] for ileostomy prolapse. Abdominal tuberculosis presents with pain abdomen, anorexia, vomiting and with signs of intestinal obstruction. The surgical procedures like resection with primary anastomosis have satisfactory outcome. Two stage surgical procedures are advisable if the risk of anastamotic leakage and faecal fistula formation is high

Clinical presentations, diagnosis and pattern of intestinal tuberculosis our experience, Nishtar hospital Multan, Pakistan

To discuss clinical presentations, diagnosis and pattern of intestinal tuberculosis of the patients presenting in surgical department. Design. Retrospective study. Place and duration of study. Nishtar Hospital Multan, Pakistan during the period of January 2002 to August 2004. Patients and methods. 109 diagnosed cases of intestinal tuberculosis were included in this study. Patients with intercurrent illness and patients proved to have other diagnosis after full work up were excluded from the study. A detailed history and full physical examination of all patients was recorded. Later on various investigations, operative findings were also noted. Results. The ages of patients were in range of 12-54 years. Male to female ratio was approximately 1:2. Clinical presentation was quite variable ranging from abdominal pain present in 100 patients [91.74%] to weight loss noted in 54 patients [49.54%]. Endoscopic biopsy and PCR analysis were most useful in diagnosing intestinal tuberculosis in elective ca ses. Strictures of the small bowel were commonest pattern noted. Past history of pulmonary tuberculosis was present in 8 patients [7.33%] while 18 patients [16.51%] had previous history of intestinal tuberculosis. 35 patients [32.11%] had positive family history of tuberculosis. 18.34% of the patients had secondary tuberculosis. Conclusion. Intestinal tuberculosis is a common disease in third decade in the developing countries. Females are more affected than males. Primary tuberculosis is more common than secondary tuberculosis. Intestinal tuberculosis may present with a variety of abdominal symptoms and signs. Endoscopy and PCR analysis can be considered as reliable investigation in elective cases. Strictures, mass abdomen and intestinal perforation are the most common pattern observed

Tuberculosis intestinal y peritoneal / Intestinal and peritoneal tuberculosis

Se revisaron 140 historias clínicas de pacientes mayores de 14 años con el diagnóstico de tuberculosis (TBC) intestinal y/o peritoneal según criterios diagnósticos pre establecidos, en un periodo de dieciocho años, en el Hospital Nacional Cayetano Heredia. La localización intestinal estuvo presente en el 48.5 por ciento, la peritoneal en el 33 por ciento y ambas en el 18.5 p[or ciento; siendo en conjunto el 4.5 por ciento de todas las formas de presentación de la TBC. Elgrupo de edad más comprometido fue el de 14 a 24 años, con un ligero predominio no significativo del sexo femenino sobre el masculino; la mayoría provenía de las zonas urbano marginales de Lima y regiones más pobres del país. En la mayoría el inicio fue insidioso y el curso previo a la hospitalización de uno a seis meses. No hubo un síndrome característico, sin embargo fue frecuente la disminuciónde peso, el dolor abdominal y las diarreas; entre los exámenes de laboratorio se evidenció importantemente hipoalbuminemia y anemia. El diagnóstico se realizó por estudios histopatológicos en quienes fue posible, contando con la ayuda de la radiología, ecografía y baciloscopía directa. La tuberculosis intestinal y/o peritoneal se asoció a la localización pulmonar en el 84.5 por ciento de los casos. En cuanto al tratamiento no hubo diferencia significativa en la respuesta a los diferentes esquemas empleados presentando evolución buena intrahospitalaria los dos tercios de los pacientes. La complicación más frecuente fue la obstrucción intestinal. Fallecieron en total el 14.5 por ciento. Si bien la evolución y el pronóstico ha mejorado, aún existe un elevado riesgo de muerte por esta enfermedad en países en vías de desarrollo como el Perú

Tuberculosis abdominal / Abdominal tuberculosis

Se evaluaron 20 casos de tuberculosis (TBC) abdominal; de los cuales 10

Tuberculosis digestiva / Digestive tuberculosis

En base a la experiencia clínica obtenida al estudiar 123 pacientes con TBC intestinal y/o peritoneal, el autor hace una revisión completa de los aspectos epidemiológicos y ambientales de la enfermedad así como la descripción de los tipos anátomo-patológicos. Las presentaciones clínicas así como la importancia de los métodos para asegurar el diagnóstico son evaluados; se hace mención del manejo terapeútico y del diagnóstico y tratamiento de las compliaciones

Abdominal tuberculosis in children.

Problems in the management of abdominal tuberculosis in children are discussed with reference to 80 surgically proven cases. The protean clinical manifestation depends on the site and the extent of the disease and its complications. The clinical diagnosis is difficult because of the vague symptoms, non-specific signs, and non-availablity of specific diagnostic tests. The most common type of pathology seen in abdominal tuberculosis in the paediatrics age were adhesive variety followed by nodal type. Strictures of the small bowel are uncommon and hyperplastic variety is rarely seen in this age group. Response to the antitubercular drugs is excellent however, the post operative complications and mortality remain high.

Tuberculosis digestiva / Digestive tuberculosis

Se estudiaron retrospectivamente 202 pacientes con tuberculosis digestiva en el Hospital "Hipólito Unánue" de Lima-Perú. La localización digestiva fué usualmente secundaria al compromiso pulmonar 88.8% (160/180). Los pacientes refirieron dolor abdominal en el 100% y diarrea en 74.8% de los casos; 48% llegaron con severo compromiso del estado general. Ningún síntoma o signo es patognomónico. En los exámenes auxiliares se detectó leucocitosis en 53.5%, anemia en 84. 1% (27% con anemia severa) y aumento de la velocidad de sedimentación en 97%. La investigación bacteriológica seriada de esputo, jugo gástrico, líquido ascítico y heces, es fundamental; el estudio del líquido ascítico en 45% de los pacientes (91/202) demostró: características de exudado en 96%, 4% de trasudado y 2.6% con aspecto quiloso. Se aisló BK del líquido ascítico en 53.4% (31/58) y BK en las heces de 30.6% (17/56). En 76 casos se pudo determinar la forma anátomo-clínica: ulcerada 51. 3% (39/76), hipertrófica 15.8% (12/76) y mixta 32.9% (25/76). 18. 3% (37/202) de los pacientes, fueron sometidos a laparotomía exploratoria, de éstos 64% (24/37) correspondieron a formas obstructivas, 27.1% (10/37) por perforación intestinal. 4 pacientes (4/202) presentaron hemorragia digestiva masiva, 1 de ellos fue intervenido quirúrgicamente a nivel de la región ileo-cecal. El tratamiento fué favorable en 55.9%, en 11.9% la evolución fué tórpida y en 26.3% (53/202) no pudo evitar el fallecimiento; la alta mortalidad es explicable debido a que éstos pacientes llegaron con severo compromiso del estado general

[Gastro-intestinal tuberculosis [21 cases]]

21 cases of gastrointestinal tuberculosis were diagnosed within 4 years ileocaecal [10], colic [7], small bowel [4] and gastroduodenal [2]. More than one localisation was encountered in 7 patients. In 10 cases, the presence of fistulas whether blind or communicating was noticed. The diagnostic criterious were either a positive histological examination, or the association of suggestive radiological aspects and a pulmonary or peritoneal tuberculosis, or a positive tuberculous test treatment. The clinical, biological, pathological and the radiological aspects of the gastrointestinal tuberculosis as well as the problems of the differential diagnosis, are discussed