Colonic tuberculosis mimicking Crohn's disease: An exceptional cause of massive surgical rectal bleeding

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis

“…In these cases, the initial symptoms include abdominal pain, 1 – 17 diarrhea, 1 , 2 , 4 , 7 – 9 , 11 , 12 , 14 , 17 – 20 weight loss, 1 , 4 , 7 , 9 – 11 , 13 – 19 fever, 2 , 3 , 6 – 9 , 11 , 13 , 16 , 17 , 19 hematochezia, 5 , 18 , 21 , 22 anorexia, 1 , 6 , 10 , 14 , 15 , 17 vomiting, 1 , 7 , 10 , 15 , 17 intestinal obstruction, 3 , 6 and dyspnea. 2 The abdominal physical examinations were normal or not described in most cases.…”

“…These data indicated that discriminating between ITB and CD is especially difficult because the clinical presentation is equivocal and nonspecific, and the diagnostic value of the clinical features is not high. The laboratory features mainly included anemia, 1 , 2 , 9 – 12 , 16 , 18 , 19 raised erythrocyte sedimentation rate (ESR), 4 , 9 , 12 , 17 – 19 and raised C-reactive protein (CRP). 4 , 14 , 18 , 19 Other laboratory features were normal or not described.…”

“…The CT images indicated that the locations of the lesion involvement were as follows: ileum, 1 , 2 , 6 , 8 – 10 , 17 , 23 ileocecal valve, 2 , 3 , 8 , 12 , 19 right colon, 2 , 4 , 5 , 8 , 11 , 13 – 16 sigmoid colon, 8 , 22 rectum, 18 , 19 and stomach. 7 Both CD and ITB can involve any segment of the gastrointestinal tract.…”

“…The CT imaging morphology findings can be summarized as follows: segmental and irregular thickening of the involved bowel, 1 , 4 , 6 , 8 , 9 , 11 , 12 , 14 , 16 , 22 , 23 enlarged lymph nodes, 4 , 8 , 12 , 14 , 23 fistula, 18 and ascites. 14 However, none of these findings could be used to distinguish CD from ITB.…”

“…Interestingly, almost all ITB patients were associated with normal chest radiographs. Among the colonoscopy features, pseudopolyps 1 , 2 , 5 , 9 , 11 , 19 and ulcerative lesions 1 , 2 , 4 – 6 , 9 , 10 , 12 , 14 , 15 , 17 – 20 , 23 were the most common reasons for misdiagnosis. Other reasons included exudates, 2 , 4 nodularity, 2 , 16 , 17 cobblestone mucosa, 4 and skip areas of inflammation and ulceration.…”