Colonoscopic study of 50 patients with colonic tuberculosis.

Abstract

Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%) Results Colonic tuberculosis was diagnosed in 50 patients during this 10 year study period. Sixteen had disease confined to the ileocaecal region, 14 had ileocaecal and contiguous involvement of variable lengths of the ascending colon, 13 had segmental colonic tuberculosis with involvement of the ascending colon in five, transverse colon in six, and descending colon in two. Five had ileocaecal and non-confluent involvement of another part of the colon, and in two the entire colon was affected.Abdominal pain occurred in 90%, weight loss in 74%, anorexia in 60% and fever and diarrhoea in 56% of all patients. None had pulmonary symptoms.A firm, usually tender abdominal mass of variable size (58%), and ascites (10%) were the only abnormal physical findings. The erythrocyte sedimentation rate was raised (>30 mm/h) in 38 of the 50 patients.Chest radiographs showed evidence of healed tuberculosis (fibrosis and/or calcification) in nine patients and active pulmonary tuberculosis (presence of acid fast bacilli in the sputum and/or gastric juice) in seven patients with ileocaecal disease and in both patients with pancolitis. COLONOSCOPYUlcerated areas a few millimetres up to 2 cm long, and a nodular friable mucosa were the most common lesions. These were often present in the same patient. The areas of ulceration were superficial and generally had sharply defined but irregular margins. The ulcer base was not friable and was covered with slough which was difficult to wash away. The surrounding mucosa was nodular and hyperaemic and blended imperceptibly with normal mucosa. In two patients numerous pale, polypoidal mucosal lesions of variable size arising from a slightly hyperemic mucosa were seen, and in one patient a solitary linear ulcer in the caecum was present. When the ileocaecal valve was involved it was oedematous and deformed and usually had areas of superficial ulceration. In the two patients with diffuse involvement of the colon, the mucosa from the rectum to the caecum was hyperaemic and friable 347 on 9 May 2018 by guest. Protected by copyright.

Tubercular bowel perforation: what to do?

“…[45] Resection and anastomosis is therefore recommended, [46] especially if combined with postoperative anti-tubercular therapy. [47][48][49] However, regardless of the surgical procedure, the mortality rate is relatively high, ranging from 30% [45,46] to 60%. [12] This high rate of mortality is principally due to the poor clinical perioperative conditions of patients undergoing surgery.…”

Tuberculosis Intestinal Secundaria: Hallazgos Morfológicos en un Caso con Desenlace Fatal

“…La confirmación diagnóstica requiere demostrar la presencia de M. tuberculosis a partir del tejido afectado o evidencia de TB en otro sitio con presencia de granulomas caseificantes en el intestino, siendo la colonoscopía con obtención de muestras para estudio histopatológico la herramienta diagnóstica más útil (Bhargava et al, 1985;Kim et al, 1998;Shah et al, 1992;Singh et al, 1996). Los hallazgos histológicos típicos consideran la presencia de granulomas caseosos con células gigantes de Langhans, sin embargo, su presencia en muestras endoscópicas es muy variable (0-44%), por lo que su ausencia ante la sospecha clínica no debe descartarla, pues se localizan en las capas profundas de la pared intestinal, hecho que explica que en piezas quirúrgicas de pacientes operados por complicaciones (obstrucción intestinal, hemorragia o perforación), se identifiquen con mayor frecuencia.…”

“…Junto con esto, la demostración de bacilos ácido alcohol resistentes con la tinción de Ziehl Neelsen confirmarían el diagnós-tico, resultando positiva entre 35-60% de los casos. Ahora bien, en casos de ausencia de hallazgos histológicos típicos o no demostrar la presencia de bacilos ácido alcohol resistentes en la tinción de Ziehl Neelsen y de persistir la sospecha clínica, la amplificación del ADN de M. tuberculosis mediante la reacción en cadena de la polimerasa (PCR) sería de utilidad en estos casos (Bhargava et al;Chatzicostas et al, 2002;Kim et al;Misra et al, 1999;Shah et al;Singh et al). En este caso evidenciamos la presencia de granulomas caseosos con escasas células gigantes de Langhans, demostrándose con Ziehl Neelsen bacilos ácido alcohol resistentes confirmado esto mediante la amplificación del ADN de M. tuberculosis mediante PCR La mortalidad de la TB intestinal sin mediar tratamiento farmacológico es de 20-50%, disminuyendo a 2-21% con tratamiento anti-tuberculoso oportuno.…”

Intestinal tuberculosis in immunocompetent/HIV negative patients: case report of two patients

“…The symptoms of gastrointestinal TB are unspecific, and, in the absence of pulmonary TB, diagnosis becomes extremely difficult 11 . In the cases reported here, serology for HIV was negative in both patients, and they denied previous tuberculosis, with normal thorax radiography.…”