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Obstrucción duodenal y hemorragia digestiva alta como presentación inicial de una tuberculosis duodenal aislada / Duodenal obstruction and upper gastrointestinal bleeding as the initial presentation of an isolated duodenal tuberculosis
Meregildo-Rodríguez, Edinson; Méndez-Florián, Katherine; Espino-Saavedra, Walter.
  • Meregildo-Rodríguez, Edinson; Hospital Regional Lambayeque. PE
  • Méndez-Florián, Katherine; Universidad Nacional Pedro Ruiz Gallo. Lambayeque. PE
  • Espino-Saavedra, Walter; Hospital Regional Lambayeque. PE
Rev. chil. infectol ; 36(3): 387-391, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1013798
RESUMEN
Resumen La tuberculosis duodenal primaria es muy infrecuente, incluso en regiones endémicas. El diagnóstico plantea un gran reto, y requiere un alto índice de sospecha, apoyado en estudios de imágenes, microbiología, e histopatología obtenida por biopsia endoscópica o quirúrgica. Presentamos el caso de un varón de 31 años, sin infección por VIH ni antecedente de tuberculosis, que debutó con una obstrucción duodenal. Posterior a una laparatomía exploradora presentó una estenosis duodenal y una hemorragia digestiva alta. Luego de varias biopsias no concluyentes, sólo la última, realizada con la técnica "biopsia sobre biopsia", demostró la presencia de granulomas con bacilos ácido-alcohol resistentes. El diagnóstico de tuberculosis fue confirmado por reacción de polimerasa en cadena de tejido duodenal. No se evidenció compromiso de otros órganos. La respuesta terapéutica fue excelente.
ABSTRACT
Primary duodenal tuberculosis is rare, even in endemic regions. The diagnosis poses a major challenge and requires a high index of suspicion, supported by imaging studies, microbiology, and histopatology obtained by endoscopic or surgical biopsy. We report the case of a 31-year-old man, without HIV infection or any previous history of tuberculosis, who presented with duodenal obstruction. After exploratory laparotomy, he presented a duodenal stenosis and upper gastrointestinal bleeding. A total of four diagnostic procedures (one laparotomy and three endoscopies) were performed, all of which included biopsies. Only the last endoscopy made with the technique "biopsy upon biopsy" showed the presence of acid fast bacilli and granulomas. The diagnosis of tuberculosis was confirmed by polymerase chain reaction in duodenal tissue. There was no evidence of involvement of other organs by tuberculosis. The patient had an excellent therapeutic response.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Tuberculosis, Gastrointestinal / Duodenal Obstruction / Gastrointestinal Hemorrhage Limits: Adult / Humans / Male Language: Spanish Journal: Rev. chil. infectol Journal subject: Communicable Diseases Year: 2019 Type: Article Affiliation country: Peru Institution/Affiliation country: Hospital Regional Lambayeque/PE / Universidad Nacional Pedro Ruiz Gallo/PE

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Full text: Available Index: LILACS (Americas) Main subject: Tuberculosis, Gastrointestinal / Duodenal Obstruction / Gastrointestinal Hemorrhage Limits: Adult / Humans / Male Language: Spanish Journal: Rev. chil. infectol Journal subject: Communicable Diseases Year: 2019 Type: Article Affiliation country: Peru Institution/Affiliation country: Hospital Regional Lambayeque/PE / Universidad Nacional Pedro Ruiz Gallo/PE