An unusual case of gastric outlet obstruction caused by tuberculosis: challenges in diagnosis and treatment

Abstract

Gastroduodenal tuberculosis (GDTB) is rare in the West. Its presentation can be non-specific and often mimics other more common conditions such as peptic ulcer disease, malignancy and Crohn's disease. Our case describes a 33-year-old Indian immigrant who presented with a 3-year history of dyspepsia and underwent balloon dilation for gastric outlet obstruction (GOO). While biopsies from the duodenum revealed only non-caseating granuloma, a high index of suspicion was maintained and colonoscopy, performed despite the absence of lower gastrointestinal symptoms, revealed a single discrete nodular and ulcerated area in the proximal transverse colon; this eventually grewMycobacterium tuberculosis. Our patient avoided undergoing major surgery and was successfully treated with balloon dilation and antitubercular medication. We highlight the importance of having a concerted, proactive approach to diagnosis. We discuss the therapeutic challenges involving this rare condition and explain the rationale for high-dose antisecretory therapy.

Gastric Tuberculosis with Outlet Obstruction: A Case Report Presenting with a Mass Lesion

“…Involvement of stomach is considered to be rare and is usually secondary to pulmonary tuberculosis [2]. Primary and isolated gastric tuberculosis without evidence of lesions elsewhere is uncommon with only a few cases reported in the literature [1, 4, 6]. The reason for relative rarity is attributed to bactericidal property of gastric acid, scarcity of lymphoid tissue in gastric wall, and the intact gastric mucosa of the stomach.…”

“…Few cases have unusual presentation as gastrobronchial fistula and massive hematemesis [8, 9]. Our case presented with a mass lesion at the antrum with gastric outlet obstruction, which is the most common presentation of gastric tuberculosis [6, 10, 11]. Tuberculous lesions of the stomach are usually located on the lesser curvature of the antrum and often involve the duodenum with few reports of the involvement of the gastroesophageal junction [10, 12].…”

Gastric tuberculosis mimicking submucosal tumor: a case series

“…The clinical manifestations of gastric tuberculosis are often not specific [4]. Upper abdominal discomfort or pain is the most common symptom; some patients have tuberculous blood symptoms, and a few patients may have upper gastrointestinal bleeding [5] or pyloric obstruction [6,7]. All 3 patients we report herein were admitted for upper abdominal discomfort or pain.…”

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

“…Although preoperative diagnosis of duodenal TB is exceedingly rare[ 17 , 26 ], Debi et al [ 14 ] have demonstrated that an endoscopic ultrasound is a valuable modality for characterizing lesions and obtaining samples for cytological confirmation[ 1 ]. In cases where histological diagnosis cannot be established by other means, intraoperative fine-needle aspiration cytology may be employed to obtain samples from the affected duodenal section[ 27 ].…”