A rare case of gastric fundus tuberculosis with nonspecific abdominal pain

Abstract

A 53-year-old patient who experienced recurring upper abdominal pain and discomfort for 4 years was admitted to our hospital. Gastroscopy was performed to identify the location of the pain and evaluate the characteristics of a mass in the abdomen. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) revealed a space-occupying lesion in the gastric fundus, suggestive of a submucosal tumor and highly likely of stromal origin. Surgical resection of the lesion was performed for identification; however, postoperative histopathological examination of the lesion revealed gastric fundus tuberculosis (TB). Gastric TB is relatively rare; therefore, clinicians should be highly suspicious of patients with abdominal symptoms from regions with a high incidence of TB to prevent treatment delay caused by misdiagnosis.

Primary Gastric Tuberculosis in an Immunocompetent Patient: The Truth Lying beneath the Surface

“…This characteristic along with the low index of suspicion for this entity, especially in non-endemic regions, is responsible for delayed diagnosis. Abdominal pain and vomiting were the main symptoms in this case, and according to a recent systematic review [8], they are present at diagnosis in 43.5% and 64.4% of cases, respectively. Constitutional symptoms associated with tuberculosis such as anorexia, weight loss, night sweats, fever, and fatigue may also be present.…”

“…With regard to endoscopic findings, in our case, there were no specific lesions, only small erosions. However, ulcerated or hypertrophic gastric lesions, often causing strictures and mimicking gastric neoplasms, are consistently described in the literature [ 4 , 5 , 7 , 8 ]. Lesions are more frequent in the lesser curvature of the gastric antrum, next to the pylorus, due to the presence of lymphoid follicles in this location and the high incidence of gastric ulcers in this topography, which break the integrity of the mucosa [ 8 ].…”

“…The diagnostic yield of these methods may be compromised in cases of gastric tuberculosis since the pathological findings may be present only in the submucosa [ 8 , 11 ]. Bite-on-bite biopsies (bites are taken sequentially at the same location to expose the submucosa), as well as endoscopic ultrasound-guided biopsies, may be particularly useful in allowing the acquisition of histological material from deeper layers [ 12 ].…”