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Ultrasound image. Multiple enlarged conglomerate lymphnodes in retroperitoneum with hypoechoic centers due to caseation.
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Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. A...
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... the most common presentation is presence of multiple mildly enlarged nodes in clusters which are circular or ovoid. They usually have central areas of caseous necrosis with peripheral enhancement (Figure 3). ...
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... addition, there may be calcified lymphnodes, calcified granulomas and hepatosplenomegaly. The features which may be seen in barium studies are accelerated intestinal transit; hyperseg- mentation of the barium column ("chicken intestine"), precipitation, flocculation and dilution of the barium; stiffened and thickened folds; luminal stenosis with smooth but stiff contours ("hourglass stenosis"), mul- tiple strictures with segmental dilatation of bowel loops; and fixity and matting of bowel loops ( Figure 13A). Vari- ous signs have been described in the ileocecal TB are the "Fleischner" or "inverted umbrella" sign, in which there is thickening of the lips of the ileocecal valve and/or wide gaping of the valve with narrowing of the termi- nal ileum. ...
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... appears as a narrowing of the terminal ileum with rapid emptying into a shortened, rigid or obliterated ce- cum. The "String sign" shows persistent narrow stream of barium indicating stenosis ( Figure 13B). Both Stierlin and String signs can also be seen in CD and hence are not specific for TB [34] . ...
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Tuberculosis involvement of the gastrointestinal tract, peritoneum, and associated viscera is an uncommon but well described entity. While peritoneal tuberculosis and tuberculous enteritis are more common, involvement of the esophagus, stomach, colon, rectum, anus, liver, bile ducts, gallbladder, and pancreas can occur. Diagnosis is challenging as...
Citations
... Extrapulmonary involvement of mycobacterial infections are well described and most often include cutaneous or gastrointestinal manifestations depending on species. Gastrointestinal involvement is reported in 1-3% of patients mTB [5], most commonly in the ileocecal region [6]. GI involvement in mTB can occur either as a result of ingesting infected sputum or as a primary infection by drinking infected milk without pulmonary involvement. ...
... GI involvement in mTB can occur either as a result of ingesting infected sputum or as a primary infection by drinking infected milk without pulmonary involvement. The most common findings in colonoscopy are linear/fissured ulcers covered with dull white/yellow exudates, strictures, deformed cecum, incompetent ileocecal valve, or fistulas [6,7]. ...
Citation: Damughatla AR, Koleti P, Almujarkesh MK, et al.
... Furthermore, for a number of patients, pleural effusion might be the only radiologic presentation (11). Frequent ultrasonography and computed tomographic presentations include ascites, thickening of the viscera (omental, mesenteric, peritoneal, and intestinal), adhesions between viscera, and lymphadenopathy (12,13), the same as our patient. Laparoscopic studies reported exudative, cloudy ascites with multiple whitish nodules or tubercles with the visceral and parietal peritoneum demonstrating extensive adhesions and omental thickening (14). ...
... The clinical presentation of GITB can range from fever, abdominal pain/distention, ascites, and diarrhea to more serious complications like GI bleeding, bowel obstruction, and perforation. Most patients respond well to standard anti-tuberculosis therapy; however, diagnostic delays and frequent misdiagnosis can necessitate surgical intervention secondary to complications [6]. ...
... The risk factors for developing TB include diabetes, renal disease, a weakened immune system (HIV or AIDS), underlying malignancy, tobacco use, and malnourishment. However, a significant number of patients with miliary TB do not have any underlying risk factors, and only 15%-25% of abdominal cases of TB have pulmonary involvement [1,4,6]. As in our case, the patient denied a history of smoking or alcohol use but was on immunosuppressive medication for rheumatoid arthritis. ...
... In some rare cases, these bacilli can get into the portal circulation or hepatic artery and spread into the solid organs of the GIT [8]. Other modes of abdominal TB infection include hematogenous spread from tubercular foci elsewhere in the body, direct spread from the infected adjacent foci, and lymphatic spread from infected lymph nodes through the lymphatic channels [6]. ...
... 3,4 The routes of MTB spread to the pancreas include hematogenous spread, ingestion of sputum containing the organism, and direct spread from adjacent organs. 5 The most common location of involvement in the pancreas is the head, followed by the body, uncinate process, and then the tail. 6 Pancreatic TB can present in a variety of ways including abdominal pain with fever and weight loss, upper GI bleeding (UGIB), obstructive jaundice, pancreaticobiliary fistula, acute or chronic pancreatitis, and portal hypertension. ...
Pancreatic tuberculosis (TB) warrants heightened suspicion in individuals with pancreatic lesions and risk factors such as HIV, organ transplantation, or pertinent immigration history. We present a 38-year-old man who presented with hemodynamically unstable gastrointestinal bleeding. He was found to have pancreatic TB complicated by a duodenal ulcer with fistula. Following 1 month of antitubercular therapy, he experienced complete resolution of symptoms, healing of the duodenal ulcer, closure of the fistulous tract, and a decrease in the size of the pancreatic lesion as observed on imaging. Our case highlights the importance of early diagnosis and treatment of pancreatic TB.
... research by Awasthi et al.9 Clinical signs, such as tenderness and prolonged pain duration, contribute to the elusive nature of early diagnosis, as identified in our study. The nonspecific symptomatology echoes observations by Debi et al emphasizing persistent challenges in distinguishing abdominal TB from other gastrointestinal disorders.10 These collective findings underscore the imperative for heightened vigilance among healthcare professionals when managing patients with a history of TB contact. ...
Background: Intestinal tuberculosis (TB) remains a global health challenge, especially in regions with a high TB prevalence. This manifestation, distinct from pulmonary TB, involves the gastrointestinal tract, often leading to intestinal obstruction. The study addresses the insidious nature of the disease, emphasizing the urgency for timely diagnosis and intervention. Recognizing the multifaceted impact of TB on various organs, the study explores the pathophysiology, clinical presentation, and diagnostic complexities of intestinal TB. Methods: This study was conducted at Nalanda medical college and hospital in Patna, Bihar, India, the retrospective study spans three years focusing on 127 patients with intestinal obstruction due to TB. Inclusion criteria prioritized histopathological confirmation of TB, ensuring cohort accuracy. The study employed preliminary investigations, including hemogram, chest X-ray, abdominal X-ray, ultrasonogram, sputum examination, and Mantoux test and CECT whole abdomen. Clinical presentations were systematically analyzed, guiding tailored management protocols based on the mode of presentation. Results: Demographically, the study identified TB as the cause in 127 cases, with a balanced gender distribution and a peak incidence in the 21-30 years age group. Presentations varied, predominantly with acute symptoms. Common complaints included abdominal pain, vomiting, constipation, and distension. Surgical intervention within 24 hours was crucial in 61.1% of cases. Intraoperatively, findings comprised mesenteric thickening, lymph nodal enlargement, and adhesions. Adhesionolysis was the primary procedure. Postoperative complications, mainly wound infections, were noted but had a limited impact on mortality. Conclusions: This study reveals TB as a significant contributor to intestinal obstruction, emphasizing challenges in early diagnosis. Adhesionolysis emerges as a key operative procedure, underscoring the need for surgical flexibility. Postoperative complications, while notable, have minimal impact on mortality.
... many times abdominal tuberculosis is associated with pulmonary tuberculosis as seen in our case. It was found that approximately 15 -20% of abdominal tuberculosis cases are associated with pulmonary tuberculosis.(10) India 2.8% of new cases of tuberculosis are having MDR or Rifampicin resistant tuberculosis. ...
Objective: Tubercular intestinal obstruction is a challenging condition often necessitating surgical intervention. This case study aims to evaluate the effectiveness of conservative management, including antitubercular therapy, short-course steroids, and dietary modifications, in resolving acute and complete intestinal obstruction caused by tuberculosis. Case Description: A 17-year-old malnourished male presented with acute abdominal pain, vomiting, and constipation. Imaging revealed mid-ileal intestinal obstruction due to tuberculosis. Conservative management, involving intravenous antibiotics, nasogastric decompression, steroids, and antitubercular treatment, led to gradual resolution. The patient experienced recurrent partial obstruction episodes, each managed conservatively with antibiotics, steroids, and dietary adjustments. A slow transition from liquid to solid diet accompanied recovery. After a year of treatment, the patient achieved recovery with weight gain. Conclusion: Tubercular intestinal obstruction, challenging to treat medically, often requires surgery. However, this case demonstrates the successful outcome through a comprehensive conservative approach. The inclusion of steroids alongside antitubercular treatment played a crucial role. Additionally, a cautious transition from liquid to solid diet post-resolution proved effective in preventing recurrence. Conservative management, when tailored to the patient's nutritional needs and disease course, can lead to favorable outcomes in tubercular intestinal obstruction.
... Abdominal TB presents with non-specific symptoms, making it challenging to differentiate it from other abdominal pathology [2]. Common clinical features include abdominal pain, ascites, weight loss, and fever [5,6]. Additionally, abdominal TB may be misdiagnosed for other peritoneal diseases such as malignancy, inflammatory bowel disease, or spontaneous bacterial peritonitis [5]. ...
... Common clinical features include abdominal pain, ascites, weight loss, and fever [5,6]. Additionally, abdominal TB may be misdiagnosed for other peritoneal diseases such as malignancy, inflammatory bowel disease, or spontaneous bacterial peritonitis [5]. Intestinal helminth co-infection is also common in TB patients [7]. ...
This case report presents a rare case of peritoneal tuberculosis (TB) coexisting with a helminthic infection in a 25-year-old female residing in Australia, highlighting the diagnostic challenges posed by abdominal TB. Despite the low incidence of TB in Western countries, abdominal TB remains a diagnostic dilemma due to its nonspecific symptoms and potential mimicry of other abdominal pathologies. The case highlights the importance of considering TB as a differential diagnosis of unexplained abdominal symptoms, particularly in individuals with a history of travel or previous residence in high-endemic regions. A multidisciplinary approach involving infectious disease specialists, radiologists, and surgeons is essential for comprehensive management. Prompt initiation of anti-TB therapy is recommended once diagnosis is confirmed.
... Esophageal tuberculosis is extremely rare, accounting for only 0.15% of tuberculosis cases (1,2), and usually affects the mid esophagus because of direct extension from mediastinal structures. Common symptoms of esophageal tuberculosis are dysphasia and retrosternal pain; however, histopathology is needed to confirm the diagnosis (3)(4)(5). Esophageal tuberculosis is difficult to identify in the absence of a mucosal lesion or at an early stage (3). Clinical, radiologic, and endoscopic findings are not well defined because of the rarity of the disease (6,7). ...
... The definitive diagnosis has been made on peritoneal biopsies with histological study [5] [6], but intraoperatively macroscopic aspects may raise suspicion of the diagnosis, particularly in the presence of whitish peritoneal nodules (76 to 100% of cases), between 0.5 and 2 mm in diameter, diffused over the peritoneum, and also by the presence of inflammation of the peritoneum and peritoneal adhesions [7]. As a result, the definitive diagnosis of peritoneal tuberculosis is still made during surgery, in particular by laparoscopy, which has a sensitivity and specificity of over 90% [8]. Treatment includes anti-tuberculosis chemotherapy with rigorous clinical and biological monitoring. ...
Tuberculosis, which is still endemic in Algeria and more generally in Africa and Asia, is a contagious microbial disease caused by Mycobacterium tuberculosis. Abdominal involvement is rare and ranks fourth among extra-pulmonary localisations. It is polymorphic and its diagnosis is often difficult. In its abdomino-pelvic location, it may mimic ovarian cancer, which may wrongly lead to extensive and morbid surgery. We report a case of peritoneal tuberculosis in a postmenopausal woman with an appearance of peritoneal carcinosis on laparoscopy.
... Histopathological examination was suggestive of acanthotic and stratified squamous epithelium admixed with granulation tissue with dense lymphoid aggregates with no evidence of malignancy. 1 Esophageal cancer is a close differential. Esophageal TB may mimic esophageal cancer both clinically, endoscopically, and radiologically. ...
Esophageal tuberculosis (TB) is a rare manifestation of extrapulmonary TB, accounting for <0.2% of all TB cases. Esophageal TB most commonly presents with dysphagia, odynophagia, retrosternal pain, and systemic symptoms like decreased appetite, loss of weight, and low-grade fever as associated or other presentations. We report a similar case recently encountered as an elderly male patient presented with chronic dysphagia to solids, loss of appetite, and significant loss of weight. Radiological and endoscopy pictures looked like esophageal cancer with histopathological examination (twice) negative for the same. Diagnosis of esophageal TB was confirmed by GeneXpert Ultra of biopsy sample and histopathological examination was suggestive of granulomatous esophagitis. The patient improved on 6 months antitubercular therapy. The unique aspect of this case was how the lesion mimicked an esophageal carcinoma on imaging which posed a diagnostic challenge. study (ODS), neck, thorax, and abdomen with positron emission tomography (PET) CT scan. The upper GI scope done outside was suggestive of strictures smooth narrowing at 27 cm. A biopsy was taken which was inconclusive. CT ODS-neck plus thorax plus abdomen was suggestive of asymmetrical circumferentially enhancing mural thickening of esophagus extending from D4 to D8 vertebral body (length-9.8 cm, thickness-8 mm) with maintained fat planes with aorta and trachea with contact with aorta <90° suspicious of neoplastic etiology. CT also showed nonnecrotic mediastinal lymph node of size 10 × 13 mm in the left paratracheal location with nodular lesions in the anterior segment of the left upper lobe (lung) possibly inflammatory or metastatic etiology. Ultrasound and CT-guided biopsy of the lymph node were not feasible as they were of small size. T he PE T-C T done out side ac tive hypermetabolic heterogeneously enhancing asymmetric circumferential transmural infiltrative mucosal thickening arising from the middle third of the thoracic esophagus with multiple metastatic mediastinal, left axillary and left supraclavicular lymphadenopathy with small volume soft tissue density nodular lesion noted involving left lung upper lobe. All routine investigations were done. Upper GI scope was done-suggestive of stricturous narrowing at 27 cm with smooth overlying mucosa. Stricture dilatation using Savary Gilliard dilators 7, 9, and 11 mm. Post dilatation-stricture seen from 27 to 32 cm. Examination is done till the second part of the duodenum-normal. A stricture site biopsy was taken. Histopathological examination was suggestive of acanthotic and stratified squamous epithelium admixed with granulation tissue with dense lymphoid aggregates with no evidence of malignancy.
