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Elgeyoushy F, Alomar TH, Alghabban MM, Alshagary RI, Alamri AM. Surprising Presentation of Intra-abdominal Tuberculosis: A Case Report. Cureus 2025; 17:e80214. [PMID: 40190942 PMCID: PMC11972610 DOI: 10.7759/cureus.80214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2025] [Indexed: 04/09/2025] Open
Abstract
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis, posing a significant global health challenge, especially in low- and middle-income countries. While it primarily affects the lungs, it can also involve other organs, leading to varied clinical manifestations. We present the case of a 49-year-old male who experienced moderate right upper quadrant pain, nausea, and tenderness for one month. Initially diagnosed with acute cholecystitis based on clinical evaluation and imaging, intraoperative findings revealed disseminated peritoneal nodules and ascitic fluid, raising suspicion of abdominal TB. A retrograde cholecystectomy and right hemicolectomy were performed, but both acid-fast bacilli (AFB) staining and polymerase chain reaction (PCR) tests returned negative results. However, histopathological examination of the gallbladder ultimately confirmed TB, prompting the initiation of treatment. This case highlights the diagnostic challenges of abdominal TB, where clinical, radiological, and molecular tests may fail to provide conclusive results. Histopathology plays a critical role in diagnosis, and effective management often requires a combination of surgical intervention and prolonged anti-TB therapy. Early recognition of abdominal TB, particularly in atypical presentations, along with a multidisciplinary approach that includes both surgical and medical management, is vital for achieving successful outcomes. Prioritizing histopathological examination is essential when other diagnostic tests yield inconclusive results.
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Affiliation(s)
| | - Taif H Alomar
- General Surgery, King Faisal Specialist Hospital and Research Centre, Medina, SAU
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2
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Liu WJP, Wu MY, Zaborowski M, Ng E. Obstructive jaundice caused by an abdominal tuberculous mass lesion. Clin J Gastroenterol 2025; 18:202-207. [PMID: 39604756 DOI: 10.1007/s12328-024-02070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024]
Abstract
Tuberculosis is a global epidemic infection that typically presents with symptoms affecting the respiratory system. Abdominal tuberculosis is an uncommon manifestation, occurring in only 5% of tuberculosis cases globally and can present with a broad range of vague symptoms that mimic other biliary and pancreatic pathologies. We report a case of a 36-year-old woman presenting with jaundice and biliary obstruction secondary to abdominal tuberculosis. Computed tomography and magnetic resonance cholangiopancreatography revealed a loculated retroperitoneal mass abutting the pancreatic head and duodenum with associated common bile duct dilatation. Endoscopic ultrasound demonstrated an ulcerated mass in the duodenum which was biopsied. Necrotising granulomas were identified on histology and the biopsied tissue was positive on tuberculosis polymerase chain reaction testing. Thus, extrapulmonary abdominal tuberculosis was diagnosed. The patient was commenced on a 6-month course of rifampicin, isoniazid, pyrazinamide and ethambutol treatment and demonstrated complete response to medical therapy. Abdominal tuberculosis can be difficult to diagnose but should remain an important differential to be considered for patients with previous travel or residence in endemic areas presenting with gastrointestinal symptoms. Prompt diagnosis and treatment can prevent unnecessary procedures, complications and death in patients with biliary obstruction caused by abdominal tuberculosis.
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Affiliation(s)
| | - Michael Yulong Wu
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew Zaborowski
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Eugene Ng
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
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3
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Ghabisha S, Ahmed F, Almohtadi AM, Alghazali KA, Badheeb M, Al-Wageeh S. Demographic, Clinical, Radiological, and Surgical Outcome of Patients with Intestinal Tuberculosis: A Single-Center Retrospective Study. Res Rep Trop Med 2024; 15:79-90. [PMID: 39253062 PMCID: PMC11382657 DOI: 10.2147/rrtm.s465571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/31/2024] [Indexed: 09/11/2024] Open
Abstract
Background Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome. Methods This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed. Results 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%). Conclusion Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up.
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Affiliation(s)
- Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
| | - Abdullatif Mothanna Almohtadi
- Department of Radiology, School of Medicine, Ibb University, Ibb, Yemen
- Department of Radiology, Ibb Scan Center, Ibb, Yemen
| | - Khairalah Abdulkarem Alghazali
- Department of Radiology, Ibb Scan Center, Ibb, Yemen
- Department of Medical Immunology and Microbiology, School of Medicine, Jiblah University for Medical and Health Sciences, Ibb, Yemen
| | - Mohamed Badheeb
- Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USA
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen
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Feng B, Ma Q, Wang H, Zhao T, Tian Y, Dong Y, Zhao Q. A case of peritoneal Burkitt's lymphoma mimic of peritoneal tuberculosis. Respir Med Case Rep 2024; 47:101979. [PMID: 38292731 PMCID: PMC10825563 DOI: 10.1016/j.rmcr.2024.101979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Peritoneal lymphomatosis is a rare presentation of lymphoma that can mimic peritoneal tuberculosis. The computed tomography findings in both conditions include omental caking, thickening, and nodularity. We report the case of a 41-year-old man who presented with intermittent abdominal pain and distension. Abdominal CT initially suggested peritoneal tuberculosis due to the thickening of the peritoneum and greater omentum with multiple nodules. However, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images showed diffuse metabolic activity increase in the thickened peritoneum, omentum, and mesentery. An omental biopsy was performed under ultrasonography guidance, and histopathological examination revealed a high-grade Burkitt lymphoma. It is crucial to distinguish peritoneal lymphomatosis from tuberculosis, as the prognosis and management of the two conditions are vastly different.
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Affiliation(s)
- Bei Feng
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Qianfeng Ma
- Department of Ultrasound, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Huiwei Wang
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Haiyuan 1st Road, Futian District, Shenzhen, Guangdong, China
| | - Tingting Zhao
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Yaxin Tian
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Yiyuan Dong
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Qian Zhao
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
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Zengin O, Göre B, Sağlar Y, Şahiner ES, İnan O, Ateş İ. Poncet's disease and tubal tuberculosis: A case report. Int J Rheum Dis 2024; 27:e14883. [PMID: 37602566 DOI: 10.1111/1756-185x.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
A 25-year-old female patient was admitted to the hospital with abdominal pain, loss of appetite, and weight loss for the last 5 months. The patient underwent paracentesis five times and was referred to our clinic after peritonitis findings were detected. Tubal tuberculosis was detected during her hospitalization. The patient, who also developed joint pain, was diagnosed with Poncet's disease. She was given quadruple antituberculosis treatment. After the treatment, the patient's joint pain regressed, and the adnexal mass due to tubal tuberculosis disappeared. In this case report, we wanted to present a rare case of Poncet's disease with tubal tuberculosis.
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Affiliation(s)
- Oğuzhan Zengin
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Burak Göre
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Yunus Sağlar
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | | | - Osman İnan
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - İhsan Ateş
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
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Sghaier A, Jarrar MS, Ben Abdelkader A, Harroum M, Hamila F, Youssef S. Acute intestinal obstruction: What if it is instead colonic tuberculosis? What diagnostic and management dilemmas are there? Int J Surg Case Rep 2023; 110:108721. [PMID: 37647758 PMCID: PMC10509830 DOI: 10.1016/j.ijscr.2023.108721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Colonic tuberculosis is rare. Clinical, biologic endoscopic and radiological features are not unequivocal. A multitude of differential diagnoses interfere, including Crohn's disease and cancer. CASE PRESENTATION we present a case of a 48-year-old Tunisian female who complained from occlusive syndrome. For whom none of the various elements of the medical record, the clinical, endoscopic and radiological investigations had enabled a decision to be reached in favor of one diagnosis over the other. Several diagnoses were suggested, including Crohn's disease, neoplastic diseases and, ultimately, colonic tuberculosis, since our country was endemic for this pathology. The collegial decision of the medical staff involved in the management was to operate on the patient. Surgery was required with the intention to treat and mainly to provide histological proof of the disease. A right colectomy allowed histological examination and a diagnosis of colonic tuberculosis. DISCUSSION The diagnosis should be discussed in patient from endemic countries, who complain chronic abdominal pain, vesperal fever and weight loss for who endoscopy shows the presence of nodules or ulcers. The diagnosis is retained on the basis of pathological findings. CONCLUSIONS Because of a nonspecific clinical and endoscopic presentations, multiples biopsies even surgical resection are mandatory to rule out differential diagnosis and to confirm the diagnoses of colonic tuberculosis.
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Affiliation(s)
- Asma Sghaier
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty Of Medicine Of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia.
| | - Mohamed Salah Jarrar
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty Of Medicine Of Sousse, University of Sousse, Tunisia; Department of Anatomy, Tunisia
| | - Atef Ben Abdelkader
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty Of Medicine Of Sousse, University of Sousse, Tunisia; Department of Anatomopathology, Tunisia
| | - Mariem Harroum
- Hospital of Farhat Hached of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Fehmi Hamila
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty Of Medicine Of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Sabri Youssef
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty Of Medicine Of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
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Veron Sanchez A, Bennouna I, Coquelet N, Cabo Bolado J, Pinilla Fernandez I, Mullor Delgado LA, Pezzullo M, Liberale G, Gomez Galdon M, Bali MA. Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities. Diagnostics (Basel) 2023; 13:2253. [PMID: 37443647 DOI: 10.3390/diagnostics13132253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3-5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.
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Affiliation(s)
- Ana Veron Sanchez
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Ilias Bennouna
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Nicolas Coquelet
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | | | | | | | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Gabriel Liberale
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Maria Gomez Galdon
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Maria A Bali
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
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Jena A, Mohindra R, Rana K, Neelam PB, Thakur DC, Singh H, Gupta P, Suri V, Sharma V. Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23:46. [PMID: 36814249 PMCID: PMC9948355 DOI: 10.1186/s12876-023-02682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity. AIM To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT). METHODS We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale. RESULTS Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07-0.20, I2 = 89%) and 0.27 (95% CI 0.21-0.33, I2 = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65-0.86, I2 = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40-0.85, I2 = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13-0.32, I2 = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09-0.21, I2 = 0%). CONCLUSION Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Kirtan Rana
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pardhu B. Neelam
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dhuni Chand Thakur
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Cheng BW, Xie PW, Miao YS, Li GH. Feasibility and Safety of Transgastric Natural Orifice Transluminal Endoscopic Surgery in the Diagnosis of Ascites of Unknown Origin. J Laparoendosc Adv Surg Tech A 2023; 33:200-204. [PMID: 36201261 DOI: 10.1089/lap.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the feasibility and safety of transgastric natural orifice transluminal endoscopic surgery (TG-NOTES) combined with biopsy in the diagnosis of unknown ascites. Method: This retrospective study used data from the first affiliated hospital of Nanchang university on 51 patients who were diagnosed with ascites of unknown origin between January 2013 and May 2019 and experienced peritoneal biopsy through TG-NOTES. The outcome measures included diagnostic accuracy and procedure-related adverse events. Results: TG-NOTES was performed successfully in 46 of 51 patients, tuberculous ascites in 38 cases, carcinomatous ascites in 4 cases, cirrhotic ascites in 1 case, and 3 cases showed no obvious abnormalities in pathological result. Five cases failed to be diagnosed because of abdominal adhesions. The diagnostic rate of TG-NOTES was 84.3%. There were no severe procedure-related adverse events and no mortality. All patients had good wound healing and no complaint of discomfort on follow-up. Conclusion: The majority of ascites of unknown origin can be expounded through TG-NOTES combined with biopsy without severe complication, therefore, it is a feasible and safe method to detect the cause of unexplained ascites.
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Affiliation(s)
- Bo-Wen Cheng
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Pei-Wei Xie
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Yin-Shui Miao
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Guo-Hua Li
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
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Aregawi AB, Alem AT, Girma A. A Rare Case of Intestinal Tuberculosis with Chronic Partial Small Bowel Obstruction in a 37-Year-Old Ethiopian Man. Int Med Case Rep J 2022; 15:725-733. [PMID: 36540622 PMCID: PMC9759974 DOI: 10.2147/imcrj.s388269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/03/2022] [Indexed: 01/25/2024] Open
Abstract
Tuberculosis (TB) is a chronic granulomatous inflammatory disease that affects any part of our body. TB is a significant problem in developing countries. Intestinal TB accounts for 2% of TB cases worldwide. Terminal ileum and cecum are the two commonly affected regions because of abundant lymphoid tissue, physiologic stasis, limited digestive activity and increased fluid and electrolyte absorption rate. Intestinal obstruction is the leading complication of intestinal TB, and it occurs because of intestinal luminal narrowing, multiple strictures or adhesions. The clinical presentation of patients with intestinal TB and post-TB intestinal obstruction is non-specific. It can be acute, chronic, or acute on chronic. Uncomplicated cases of intestinal TB can be managed medically. Surgery is reserved for complicated cases of intestinal TB, which includes peritonitis, intestinal obstruction and perforations. Here, we present a 37-year-old man who presented with long-standing, intermittent crampy abdominal pain and vomiting. He was diagnosed with chronic partial small bowel obstruction secondary to possibly small bowel carcinoma. We did segmental ileal resection and end-to-end ileo-ileal anastomosis. Postoperatively, the histopathology result turned out to be intestinal TB. This case report aims to make physicians aware of the rare condition of small bowel obstruction secondary to intestinal TB. Clinicians need to have a high index of suspicion in any patient with long-standing symptoms of partial obstruction and consider surgery and anti-TB once diagnosed.
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Affiliation(s)
- Alazar Berhe Aregawi
- Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Alemwosen Teklehaimanot Alem
- Department of Pathology, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Abdulkerim Girma
- Department of Radiology, Yanet Internal Medicine Specialized Centre, Hawassa, Sidama, Ethiopia
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11
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Das P, Dixit R, Prakash A, Daga MK, Singh R. Diffusion-weighted magnetic resonance imaging of abdominal tuberculosis: a new take on an old disease. Abdom Radiol (NY) 2022; 47:3446-3458. [PMID: 35864265 DOI: 10.1007/s00261-022-03607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
Abdominal tuberculosis is a major cause of mortality and morbidity in developing countries also re-emerging in western world due to the AIDS epidemic and population migration. Large proportion of the patients are young and hence radiation exposure is of concern. In addition, in some patients, contrast may be contraindicated or repeat studies may be required, where MR especially DWI may be useful. The aim of the study is to describe MRI features in abdominal tuberculosis including DWI in the involved bowel, lymphadenopathy, omental, and peritoneal thickening. Nodes being especially easy to appreciate on DWI, thus DWI in conjunction with routine noncontrast MR sequence can be useful technique to identify abdominal tubercular lesions in patients with contraindication to contrast.
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Affiliation(s)
- Prince Das
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - M K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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12
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Park SM, Kim JH, Chong Y, Kang WK. Concurrent ascending colon adenocarcinoma and ileocecal tuberculosis: A case report. Medicine (Baltimore) 2022; 101:e29430. [PMID: 35623078 PMCID: PMC9276159 DOI: 10.1097/md.0000000000029430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma and ileocecal tuberculosis, which were nearly indistinguishable from one another. PATIENT CONCERNS A 59-year-old man visited our clinic with dizziness and anorexia. DIAGNOSIS Computed tomography revealed a mass in the ascending colon with ill-defined nodules in the liver. A colon biopsy showed adenocarcinoma with multinucleated giant cells. The liver nodules were confirmed to be metastatic adenocarcinomas. INTERVENTIONS Ant tuberculosis medications were administered prior to surgery. Two weeks later, a laparoscopic right hemicolectomy and radiofrequency ablation of the liver were performed. OUTCOMES The final pathology confirmed adenocarcinoma with chronic granulomatous inflammation and giant cells. LESSONS In this patient, the cancer was in an advanced stage and had no history of tuberculosis infection. Thus, in this case, the malignancy seemed to create the proper environment for either reactivation of a latent tuberculosis infection or, less likely, for the acquisition of a primary mycobacterial infection. In conclusion, clinicians should be aware of the possibility of concurrent colon adenocarcinoma and intestinal tuberculosis.
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Affiliation(s)
- Sun Min Park
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yosep Chong
- Department of Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Kyung Kang
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Baleguli V, Rizvi S, Varghese M, Ilyas J. A Rare Cause of Esophageal Dysphagia – Secondary Esophageal Tuberculosis. Cureus 2022; 14:e21019. [PMID: 35154989 PMCID: PMC8820495 DOI: 10.7759/cureus.21019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It continues to be one of the most common causes of death in adults across all countries. It is found to be relatively lower in North America. When aerosol droplets that contain Mycobacteriumtuberculosis are inhaled, it can deposit in the respiratory tract, particularly in the patient’s lungs. Following this deposition, one of the four outcomes can take place. These include clearance of the organism immediately, primary disease, latent infection, and reactivation disease. Unhindered bacterial growth after primary infection can lead to a hematogenous spread of bacilli to produce disseminated TB. Esophageal involvement causing esophageal TB can be primary or secondary esophageal TB. We present a unique case of secondary esophageal TB with symptoms of dysphagia and odynophagia with primary TB focus on the lung. Computed tomography (CT) of the chest noted diffuse bilateral miliary lung disease. TB QuantiFERON gold and sputum culture were positive for TB. Mycobacterial culture for identification with high-performance liquid chromatography showed isoniazid-resistant TB. The patient was started on antitubercular therapy with rifampin, ethambutol, moxifloxacin, and pyrazinamide for a total of nine months. Esophagogastroduodenoscopy (EGD) reported severe ulcerations of the oropharynx and focal ulceration in the proximal to the mid esophagus. Histopathology revealed active ulcerative and granulomatous esophagitis with mycobacterial organisms. After EGD she was started on a full liquid diet and advanced as tolerated. After discharge, she followed with the Health Department and had three negative sputum cultures after the completion of therapy.
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14
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Rathi V, Yadav V, Deep BS, Bhatt S, Giri S. CT Appearances in Treated Abdominal Tuberculosis: A Radiologist's Dilemma. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1736496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective To study the CT appearances of the abdomen after completion of antitubercular therapy (ATT) in adult patients.
Methods Multidetector CT scan abdomen was done in 20 adults within 1 month of completing ATT. CT appearances were compared with pretreatment scans which were available in 7 cases.
Results We found that residual ileocecal wall thickening and enhancement was significant (p < 0.05) after treatment in cases of ileocecal tuberculosis (TB). Mild decrease in wall thickness and diameter of the involved dilated small bowel loops was seen. Numerous large, matted nodes with necrosis persisted in the mesentery and retroperitoneum in treated TB, but reduction in the size of nodes was appreciated.
Conclusion Our results help to fill the vacuum in the database of CT appearances in treated abdominal TB. Persistence of bowel changes and lymph nodes should not be mistaken for recurrence of TB or residual disease.
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Affiliation(s)
- Vinita Rathi
- Department of Radio Diagnosis, University College of Medical Sciences & GTB Hospital, Dilshad Garden, Delhi, India
| | - Varun Yadav
- Department of Radio diagnosis, University College of Medical Sciences, Delhi, India
| | - Bonny S. Deep
- Department of Radio diagnosis, University College of Medical Sciences, Delhi, India
- Department of Radio diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shuchi Bhatt
- Department of Radio diagnosis, University College of Medical Sciences, Delhi, India
| | - Subhash Giri
- Department of Medicine, University College of Medical Sciences & GTB Hospital, Dilshad Garden, Delhi, India
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15
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Wenting J, Yuyan M, Qingfeng S, Yao Z, Yumeng Y, Yi S, Yingnan H, Qing M, Qingqing W, Mengran W, Bing L, Yu L, Sishi C, Na L, Rong B, Xiaodong G, Jue P, Bijie H. Clinical features of and diagnostic approaches for abdominal tuberculosis: 5-year experience from a non-tuberculosis-designated hospital in China. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:461-467. [PMID: 34886676 DOI: 10.17235/reed.2021.8022/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Abdominal tuberculosis (TB) is a common form of extrapulmonary TB but is still a diagnostic dilemma in clinical practice. We are aimed to highlight the clinical features of and diagnostic approaches for abdominal TB. METHODS Seventy cases of diagnosed abdominal TB were retrospectively collected at Zhongshan Hospital, Fudan University in Shanghai, China, between 1 August 2015 and 30 June 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB, or mixed TB. RESULTS Eighteen patients were diagnosed with peritoneal TB, 9 with lymph node TB, 5 with gastrointestinal TB, 2 with visceral TB, and 36 with mixed TB. Twenty-four patients had only abdominal TB, while 7 had abdominal TB combined with pulmonary TB (PTB), 19 had abdominal TB combined with extrapulmonary TB (EPTB) in one or more sites, and 20 had abdominal TB combined with both PTB and EPTB in other sites. The median diagnosis time was 60 days. Ascites(58.6%), abdominal distension(48.6%), weight loss(44.3%) and fever(42.9%) were the most common symptoms. The overall microbiological and histological confirmation rates were 70.0% and 38.6% respectively. The non-ascites samples yielded a higher microbiological confirmation rate (63.6%) than the total samples (40.8%). Diagnosis was confirmed histologically in 18 patients (69.2%). Forty-five cases (64.3%) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates. CONCLUSIONS The diagnosis of abdominal TB should be reached by a combination of clinical, laboratorial, radiographic, microbiological and pathological findings.
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Affiliation(s)
- Jin Wenting
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
| | - Ma Yuyan
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
| | - Shi Qingfeng
- Hospital Infection Management, Zhongshan Hospital. Fudan University,
| | - Zhang Yao
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Yao Yumeng
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Su Yi
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Huang Yingnan
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Miao Qing
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Wang Qingqing
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Wang Mengran
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Li Bing
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Luo Yu
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Cai Sishi
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Li Na
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
| | - Bao Rong
- Microbiology, Zhongshan Hospital. Fudan University,
| | - Gao Xiaodong
- Hospital Infection Control, Zhongshan Hospital. Fudan University,
| | - Pan Jue
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Hu Bijie
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
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Rare manifestation of a large stenosing gastrointestinal tumor caused by Mycobacterium tuberculosis in a previously healthy man from Austria. Wien Med Wochenschr 2021; 172:268-273. [PMID: 34613520 PMCID: PMC9463224 DOI: 10.1007/s10354-021-00887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal tuberculosis (TB) is a rare manifestation in low TB-incidence countries such as Austria. It is usually seen in immunocompromised patients or in migrants being more susceptible for extrapulmonary disease manifestations. CASE DESCRIPTION We report a very rare manifestation of severe gastrointestinal TB in a 49-year-old previously healthy man from Upper Austria. Endoscopy showed a large tumor mass obstructing about 2/3 of the lumen of the cecum. Positron emission tomography/computed tomography scan revealed not only a high metabolic activity in the tumor mass, but also active pulmonary lesions in both upper lung lobes. Bronchial secretion showed acid-fast bacilli in the microscopy and polymerase chain reaction was positive for M. tuberculosis complex. Phenotypic resistance testing showed no resistance for first-line anti-TB drugs. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was initiated. Based on therapeutic drug monitoring, the standard treatment regime was adapted to rifampicin high dose. TB treatment was well tolerated and the patient achieved relapse-free cure one year after the end of treatment. CONCLUSION Gastrointestinal involvement mimicking an intestinal tumor is a very rare TB manifestation in previously healthy Austrians. However, it should be kept in mind due to increasing migration from countries with higher rates of extrapulmonary TB and due to an increasing number of immunocompromised patients. TB telephone consultations can support medical professionals in the diagnosis and the management of complex TB patients. TB management is currently at a transitional stage from a programmatic to personalized management concept including therapeutic drug monitoring or biomarker-guided treatment duration to achieve relapse-free cure.
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17
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Maheshwari A, Gupta S, Rai S, Rekhi B, Kelkar R, Shylasree TS, Menon S, Deodhar K, Thakur M, Das U, Gupta S, Tandon S. Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer. South Asian J Cancer 2021; 10:102-106. [PMID: 34604126 PMCID: PMC8483894 DOI: 10.1055/s-0041-1736030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives Peritoneal tuberculosis can mimic advanced abdominal malignancy. We describe clinical and laboratory characteristics in a series of female patients with peritoneal tuberculosis who were referred to a tertiary cancer center with a diagnosis of suspected advanced ovarian/primary peritoneal cancer. Materials and Methods Details of clinical features, laboratory results including serum tumor markers, radiological findings, and ascitic fluid evaluation were retrospectively collected from hospital records for patients diagnosed to have peritoneal tuberculosis and reported descriptively. Statistical Analysis Descriptive statistics was performed using SPSS Statistics for Windows software, version 20.0 (SPSS, Chicago, Illinois). Results Between January 2009 and December 2017, 120 patients of peritoneal tuberculosis with a median age 41 years (range, 15-79 years) were identified. Of these 112 (93.3%; 95% CI 88.9-97.8%) patients had ascites and 63 (52.5%; 95% CI 43.6-61.4%) had adnexal mass at presentation. Mean serum cancer antigen 125 (CA-125) level was 666.9 (range, 38-18,554) U/mL. Ascitic fluid was negative for malignant cells in all patients and lymphocyte rich exudate was seen in 103 (91.9%; 86.9-97.0%) patients. Ascitic fluid adenosine deaminase (ADA) level was more than 40 U/L in 107 (95.5%; 95% CI 91.7-99.4%). Ascitic fluid Ziel-Neelsen staining was positive in 4/62 (6.5%; 95% CI 0.3-12.6%) patients while ascitic fluid culture examination for mycobacterium tuberculosis was positive in 7/59 (11.9%; 95% CI 3.6-20.1%) patients. The diagnosis of tuberculosis was based on image-guided biopsy in 44 (36.7%) patients, surgical biopsy in 8 (6.7%) patients, and a combination of clinicoradiological and laboratory features in 68 (56.7%) patients. All patients received standard antitubercular treatment. Conclusions The study results suggest that peritoneal tuberculosis has clinical, radiological, and serological profile which may mimic advanced ovarian/primary peritoneal cancer. Peritoneal tuberculosis should be considered in the differential diagnosis of advanced abdominal malignancy.
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Affiliation(s)
- Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Deptartment of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shweta Rai
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rohini Kelkar
- Deptartment of Microbiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meenakshi Thakur
- Deptartment of Radiodiagnosis, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ushasree Das
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Stuti Gupta
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandeep Tandon
- Department of Medicine, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Al-Zanbagi AB, Shariff MK. Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment. Saudi J Gastroenterol 2021; 27:261-274. [PMID: 34213424 PMCID: PMC8555774 DOI: 10.4103/sjg.sjg_148_21] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022] Open
Abstract
Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.
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Affiliation(s)
- Adnan B. Al-Zanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - M. K. Shariff
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
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19
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Tharakan R, John S, Devdas JM, Hegde P. Isolated hepatosplenic tuberculosis: a rare presentation with persistent fever in a 2-year-old female child. BMJ Case Rep 2021; 14:e243851. [PMID: 34389594 PMCID: PMC8365814 DOI: 10.1136/bcr-2021-243851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/04/2022] Open
Abstract
A 2-year-old female child from South India presented with persistent fever for 3 weeks, pallor and hepatosplenomegaly. There was no history of contact with tuberculosis (TB) and BCG scar was absent. Tests for TB (Mantoux and gastric aspirate) were negative. Blood and bone marrow tests for other infections, inflammation and infiltration were inconclusive. Chest X-ray was normal. Ultrasound study (USS) of abdomen showed multiple microabscesses in the liver and spleen. USS-guided fine needle aspiration cytology from splenic lesion demonstrated epithelioid granuloma while bacteriology was negative. Commencement of anti-tubercular therapy (ATT) resulted in remarkable clinical improvement in a week with resolution of lesions on follow-up USS in 2 months. Isolated hepatosplenic TB in children, though rare, has a wide, non-specific clinical spectrum and potential of delaying diagnosis. Probability diagnosis and therapeutic trials of ATT are accepted approaches, using treatment response as indirect confirmation of the likely cause.
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Affiliation(s)
- Riya Tharakan
- Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India
| | - Sujonitha John
- Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India
| | | | - Pavan Hegde
- Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India
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20
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Abstract
Gastrointestinal (GI) tuberculosis (TB) remains a significant problem worldwide, and may involve the luminal GI tract from oral cavity to perianal area in addition to associated viscera and peritoneum. Although GI TB more commonly affects immunocompromised hosts, it can also occur in immunocompetent people. Diagnosis is difficult because it usually mimics a malignancy or inflammatory bowel disease. A high index of clinical suspicion and appropriate use of combined investigative methods help in early diagnosis, and reduce morbidity and mortality. Anti-TB therapy is the same as for pulmonary disease, and invasive and specialized interventions are reserved for selected complications.
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Affiliation(s)
- Haluk Eraksoy
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, TR-34093 Istanbul, Turkey.
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21
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Mousa H, Abdel-Kader S, Abu-Zidan FM. Management of abdominal tuberculosis in a community-based hospital in a high-income developing country. World J Emerg Surg 2021; 16:25. [PMID: 34039395 PMCID: PMC8153524 DOI: 10.1186/s13017-021-00370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates. Methods All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died. Conclusions Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.
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Affiliation(s)
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE.
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22
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Gernert JA, Sirtl S, Macke L, Wittmann E, Strueven AK, Schwarze V, Dichtl K, Neumann J, Mayerle J, Schulz C. Tuberculous perihepatic abscess and neurosarcoidosis: report of 2 uncommon manifestations of 2 common granulomatous diseases in 1 patient. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:50-55. [PMID: 33429450 DOI: 10.1055/a-1330-9046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infections caused by pathogens of the Mycobacterium tuberculosis complex, i. e., tuberculosis (TB), and the non-infectious, autoimmune disease sarcoidosis are among the most common granulomatous diseases worldwide. Typically, the lung is the primary site of infection and manifestation, respectively which makes the two diseases important differential diagnoses. Both diseases can affect virtually all organ systems, albeit with significantly lower incidence. CASE PRESENTATION: We report the case of a 50-year-old Indian man presenting with a tuberculous perihepatic abscess and a systemic inflammatory response after being diagnosed with neurosarcoidosis presenting as a single granuloma in the frontal lobe with lymphadenopathy in 2014. On day of admission the patient presented with right upper abdominal pain and fever for two weeks. With increased inflammatory parameters in serum and after finding of external CT images, a perihepatic abscess was suspected. This encapsulated cave was drained percutaneously under CT control. A high concentration of acid-fast rods was detected using ZN, PCR was positive for M. tuberculosis. Several samples of sputum and urine were microscopically negative but yielded growth of Mycobacteria after four weeks. DISCUSSION: This is a case presenting with two different granulomatous diseases, each of which manifested itself in an atypical form. The tuberculous liver abscess might either be explained as a flare-up of latent tuberculosis under azathioprine therapy or as a reinfection acquired during one of several visits in the high-prevalence country India. In addition, it must be discussed whether the cerebral granuloma in 2014 could have been an early stage of tuberculous granuloma. Sensitivity of ZN staining is significantly reduced in cerebral samples, and negative PCR-results might be due to low germ load or methodical issues, e. g., decreased sensitivity in formalin fixated samples.
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Affiliation(s)
| | - Simon Sirtl
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Macke
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Elena Wittmann
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | | | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Karl Dichtl
- Max von Pettenkofer-Institut, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, LMU Munich
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
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23
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Zhang Y, Shi XJ, Zhang XC, Zhao XJ, Li JX, Wang LH, Xie CE, Liu YY, Wang YL. Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination: A case report. World J Clin Cases 2020; 8:6537-6545. [PMID: 33392342 PMCID: PMC7760418 DOI: 10.12998/wjcc.v8.i24.6537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary duodenal tuberculosis is very rare. Due to a lack of specificity for its presenting symptoms, it is easily misdiagnosed clinically. Review of the few case reports and literature on the topic will help to improve the overall understanding of this disease and aid in differential diagnosis to improve patient outcome.
CASE SUMMARY A 71-year-old man with a 30-plus year history of bronchiectasis and bronchitis presented to the Gastroenterology Department of our hospital complaining of intermittent upper abdominal pain. Initial imaging examination revealed a duodenal space-occupying lesion; subsequent upper abdominal contrast-enhanced computed tomography indicated duodenal malignant tumor. Physical and laboratory examinations showed no obvious abnormalities. In order to confirm further the diagnosis, electronic endoscopy was performed and tissue biopsies were taken. Duodenal histopathology showed granuloma and necrosis. In-depth tuberculosis-related examination did not rule out tuberculosis, so we initiated treatment with anti-tuberculosis drugs. At 6 mo after the anti-tuberculosis drug course, there were no signs of new development of primary lesions by upper abdominal computed tomography, and no complications had manifested.
CONCLUSION This case emphasizes the importance of differential diagnosis for gastrointestinal diseases. Duodenal tuberculosis requires a systematic examination and physician awareness.
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Affiliation(s)
- Yang Zhang
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Xiao-Jun Shi
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Xian-Cui Zhang
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Xing-Jie Zhao
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Jun-Xiang Li
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Lin-Heng Wang
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Chun-E Xie
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yu-Yue Liu
- Department of Pathology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yun-Liang Wang
- Department of Gastroenterology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
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24
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Bhandari B, Snyder SA, Goldman JD. Thinking Outside the Lungs: A Case of Disseminated Abdominal Tuberculosis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926194. [PMID: 33239604 PMCID: PMC7703488 DOI: 10.12659/ajcr.926194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patient: Female, 47-year-old Final Diagnosis: Intraperitoneal tuberculosis Symptoms: Abdominal pain • decreased appetite Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Medicine, General and Internal
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Affiliation(s)
- Binita Bhandari
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Samantha A Snyder
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - John D Goldman
- Department of Infectious Disease, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
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25
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Lu S, Fu J, Guo Y, Huang J. Clinical diagnosis and endoscopic analysis of 10 cases of intestinal tuberculosis. Medicine (Baltimore) 2020; 99:e21175. [PMID: 32664157 PMCID: PMC7360195 DOI: 10.1097/md.0000000000021175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/05/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
Abstract
To analyze the clinical characteristics of intestinal tuberculosis (ITB), pay attention to the diagnostic value of endoscopy and mucosal biopsy, improve the recognition of atypical manifestations of ITB under endoscopy, and reduce misdiagnosis and missed diagnosis.The clinical data of 10 patients who were hospitalized in Changzhou second people's Hospital and finally diagnosed as ITB from January 1, 2015 to present were analyzed retrospectively. The basic information, medical history, clinical manifestations and computed tomography (CT), endoscopy of the patients was analyzed retrospectively. The results of pathological examination were analyzed and sorted out.Among the 10 patients, the ratio of male to female was 7:3, 10 (100%) had abdominal pain, 3 (30%) had diarrhea and 2 (20%) had bloody stool. The positive rate of tuberculosis T cell test was 75% (6/8), the diagnostic rate of chest high resolution CT was 60%, and the abnormal rate of abdominal high-resolution CT was 66.7% (6/9). Colonoscopy showed that the lesions mainly involved ileocecum (70%) and ascending colon (60%). Most of the lesions were intestinal stenosis (60%) and circular ulcer (50%). In a few cases, cold abscess (20%) and scar diverticulum (10%). Most of the pathological manifestations were granuloma formation and multinucleated giant cells (60%). The detection rate of caseous granuloma was 20%.The general condition and clinical manifestations of patients with ITB are not specific. Endoscopy and mucosal biopsy are of great significance for its diagnosis. The clinical manifestations and endoscopy of some patients showed atypical signs. Therefore, the combination of multi-disciplinary team models and the enhancement of clinician's recognition of the characteristics of endoscopic examination of ITB can improve us the diagnosis level of ITB.
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Affiliation(s)
- Shuangshuang Lu
- School of Medical, Dalian Medical University, Dalian
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jinjin Fu
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yongxin Guo
- School of Medical, Dalian Medical University, Dalian
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jin Huang
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
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Abstract
Peritoneal tuberculosis (TB) is one of the most challenging forms of extrapulmonary tuberculosis to diagnose. This challenge can be compounded in low incidence regions, and in patients with cirrhosis in whom the presence of ascites alone may not prompt further investigation. A delay in the diagnosis and treatment of peritoneal tuberculosis may lead to worse clinical outcomes. This case describes a 64-year-old Italian male with decompensated cirrhosis being evaluated for liver transplantation, who developed abdominal pain and a persistent inflammatory ascites with peritoneal thickening despite antibiotic therapy. Peritoneal tuberculosis was suspected, although non-invasive and invasive direct mycobacterial testing remained negative. A constellation of positive QuantiFERON-TB Gold In-Tube test, elevated ascitic adenosine deaminase and dramatic symptomatic and radiographic response to empiric anti-tuberculous therapy confirmed the diagnosis of peritoneal tuberculosis. This paper will review the approach to the diagnosis of peritoneal tuberculosis.
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Affiliation(s)
- Alan Koff
- Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marwan Mikheal Azar
- Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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27
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Broza YY, Zhou X, Yuan M, Qu D, Zheng Y, Vishinkin R, Khatib M, Wu W, Haick H. Disease Detection with Molecular Biomarkers: From Chemistry of Body Fluids to Nature-Inspired Chemical Sensors. Chem Rev 2019; 119:11761-11817. [DOI: 10.1021/acs.chemrev.9b00437] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Yoav Y. Broza
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Xi Zhou
- School of Natural and Applied Sciences, Northwestern Polytechnical University, Xi’an 710072, P.R. China
| | - Miaomiao Yuan
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, P.R. China
| | - Danyao Qu
- School of Advanced Materials and Nanotechnology, Interdisciplinary Research Center of Smart Sensors, Xidian University, Shaanxi 710126, P.R. China
| | - Youbing Zheng
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Rotem Vishinkin
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Muhammad Khatib
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Weiwei Wu
- School of Advanced Materials and Nanotechnology, Interdisciplinary Research Center of Smart Sensors, Xidian University, Shaanxi 710126, P.R. China
| | - Hossam Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion—Israel Institute of Technology, Haifa 3200003, Israel
- School of Advanced Materials and Nanotechnology, Interdisciplinary Research Center of Smart Sensors, Xidian University, Shaanxi 710126, P.R. China
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Aslan B, Tüney D, Almoabid ZAN, Erçetin Y, Seven İE. Tuberculous peritonitis mimicking carcinomatosis peritonei: CT findings and histopathologic correlation. Radiol Case Rep 2019; 14:1491-1494. [PMID: 31660094 PMCID: PMC6807046 DOI: 10.1016/j.radcr.2019.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 11/26/2022] Open
Abstract
The distinction between tuberculous peritonitis and peritoneal carcinomatosis is extremely difficult in patients with omental cake appearance on computed tomography and elevated CA-125 level. A 21-year-old female presented with abdominal distention, diarrhea, nausea, fever, weight loss, and night sweats. Serum CA-125 level was 563 U/L (normal range: <35 U/L) and other tumor markers were within normal range. Radiologic studies showed massive ascites, smooth minimal thickening and increased contrast enhancement of peritoneum, omental nodularities, hepatomegaly, and right pleural effusion. No underlying malignancy that could cause this condition was detected clinically and radiologically. Ultrasound-guided omental tru-cut biopsy was performed to exclude carcinomatosis peritonei. Histopathologic examination showed small-medium-sized granulomas with caseous necrosis. Molecular microbiology tests of biopsy specimens confirmed diagnosis of tuberculosis. In conclusion, tuberculous peritonitis should be in differential diagnosis of a patient with ascites, omental nodularities and elevated serum CA-125 levels.
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Affiliation(s)
- Bülent Aslan
- Department of Radiology, Hospital of Marmara University School of Medicine, Istanbul, Turkey
| | - Davut Tüney
- Department of Radiology, Hospital of Marmara University School of Medicine, Istanbul, Turkey
| | | | - Yiğit Erçetin
- Department of Pathology, Hospital of Marmara University School of Medicine, Istanbul, Turkey
| | - İpek Erbarut Seven
- Department of Pathology, Hospital of Marmara University School of Medicine, Istanbul, Turkey
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Roberts S, Newsholme W, Gibson T. Diagnosis and management of intra-abdominal tuberculosis. Br J Hosp Med (Lond) 2019; 79:C86-C89. [PMID: 29894250 DOI: 10.12968/hmed.2018.79.6.c86] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sophie Roberts
- Acute Medicine Trainee, Department of General Internal Medicine, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH
| | - William Newsholme
- Consultant in Infectious Diseases and General Medicine, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust Infection Service, London
| | - Terence Gibson
- Consultant Physician and Rheumatologist, Department of General Internal Medicine, Guy's and St Thomas' NHS Foundation Trust, London
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Abu-Zidan FM, Sheek-Hussein M. Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay. World J Emerg Surg 2019; 14:33. [PMID: 31338118 PMCID: PMC6626328 DOI: 10.1186/s13017-019-0252-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%.
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Affiliation(s)
- Fikri M Abu-Zidan
- 1Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
| | - Mohamud Sheek-Hussein
- 2Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
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Bahadur A, Mundhra R, Chawla L, Prateek S, Chaturvedi J, Rajput R. Incidental detection of disseminated peritoneal tuberculosis-varied presentation. Indian J Tuberc 2019; 67:159-162. [PMID: 32553305 DOI: 10.1016/j.ijtb.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incidental peritoneal tuberculosis represents an uncommon variety of peritoneal tuberculosis and surgeons must be aware of this entity particularly in tuberculosis endemic zones. METHODS We prospectively analysed cases of incidental peritoneal tuberculosis detected during surgery over a period of last six months. RESULTS We herein describe three such cases of incidental peritoneal TB detected during surgical exploration for other reasons. CONCLUSION Diagnosis of disseminated peritoneal tuberculosis often remains a challenging task owing to its non specific clinical presentation and difficulty arises on seeing such a picture intraoperative and raises a question whether to proceed with the decided surgery or not. Frozen section can help in guiding further management but it is not definitive.
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Affiliation(s)
- Anupama Bahadur
- Department of Obstetrics and Gynaecology, AIIMS Rishikesh, India
| | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynaecology, AIIMS Rishikesh, India.
| | - Latika Chawla
- Department of Obstetrics and Gynaecology, AIIMS Rishikesh, India
| | - Shashi Prateek
- Department of Obstetrics and Gynaecology, AIIMS Rishikesh, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynaecology, AIIMS Rishikesh, India
| | - Rashmi Rajput
- Department of Obstetrics and Gynaecology, AIIMS Rishikesh, India
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Konstantara F, Stamopoulou S, Gkegkes ID, Kotrogiannis I, Fotiou E, Papazacharias C, Paraskevopoulos IA, Filippou D, Skandalakis P. Intra-abdominal lymphatic tuberculosis as a rare case of small intestine volvulus. SAGE Open Med Case Rep 2019; 7:2050313X19844379. [PMID: 31065355 PMCID: PMC6488773 DOI: 10.1177/2050313x19844379] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/22/2019] [Indexed: 01/25/2023] Open
Abstract
Tuberculosis used to be uncommon in the developed countries but seems to be still
on rampant in developing countries. However, there seems to be an increasing
occurrence in the developed countries too mainly due to low living conditions,
increased migration, HIV immune-compromisation and inappropriate use of
antitubercular drugs. Lymphatic tuberculosis is the second commonest
extrapulmonary location of tuberculosis followed by genitourinary, bone and
joint, miliary, meningeal and abdominal. Abdominal tuberculosis represents
nearly 11%–16% of all extrapulmonary tuberculosis locations. Furthermore,
abdominal tuberculosis co-exists with pulmonary tuberculosis in 10%–30% of
patients. Abdominal tuberculosis remains difficult to diagnose due to
non-specific symptoms, variable anatomical locations and lack of specific
sensitive diagnostic tools. Diagnosis can be rarely suspected, especially in
cases of isolated abdominal tuberculosis without clinical or radiological
findings. We present a rare case of a patient with pulmonary tuberculosis
combined with intra-abdominal lymphatic tuberculosis causing small intestine
volvulus.
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Affiliation(s)
- Filitsa Konstantara
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece.,Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria Stamopoulou
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece
| | | | - Eleftherios Fotiou
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece
| | | | | | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Skandalakis
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abaylı B, Gençdal G. A Single-Center Experience: The Diagnostic Role of Peritoneoscopy in Patients with Exudative Ascites. J Laparoendosc Adv Surg Tech A 2019; 29:51-54. [PMID: 30300097 DOI: 10.1089/lap.2018.0274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIM The causes of exudative and transudative ascites can be detected through noninvasive methods nowadays. In selected cases, peritoneoscopy could be necessary for definitive diagnosis. In this retrospective study, we aimed to present the peritoneal biopsy results of patients who had exudative ascites with unclear etiology. MATERIALS AND METHODS A retrospective analysis was performed in 86 patients who had exudative ascites of unclear etiology. All the patients showed abnormalities of the peritoneum or greater omentum as determined by abdominal ultrasonography and underwent peritoneoscopy between January 2012 and December 2015. Patient data were obtained from hospital records. RESULTS Eighty-six patients (male: 22; 25.6%, mean age ± standard deviation: 57.97 ± 15.97) who had exudative ascites of unclear etiology were included to the study. The success rate of the procedures was 100% (86/86). A specific histopathological diagnosis was made in all patients, with an overall diagnostic accuracy of 100%. Among the 86 diagnosed patients, 43 (50%) were peritonitis carcinomatosa, 21 (24.4%) were tuberculous peritonitis, 14 (16.3%) were mesothelioma, 4 (4.7%) were chronical inflammation, and 1 (1.2%) was lymphoma. Three (3.5%) patients had normal peritoneal biopsy findings. DISCUSSION Peritoneoscopy is a safe and efficient alternative method due to its high diagnostic capacity in selected patients who have exudative ascites of unclear etiology.
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Affiliation(s)
- Bahri Abaylı
- 1 Department of Gastroenterology and Hepatology, Cukurova Dr. Askım Tufekci Hospital, Adana, Turkey
| | - Genco Gençdal
- 2 Department of Gastroenterology and Hepatology, Center of Transplantation, Yeni Yuzyıl, School of Medicine, İstanbul, Turkey
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Deshpande SS, Joshi AR, Deshpande SS, Phajlani SA. Computed tomographic features of abdominal tuberculosis: unmask the impersonator! Abdom Radiol (NY) 2019; 44:11-21. [PMID: 30027495 DOI: 10.1007/s00261-018-1700-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. METHODS We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. RESULTS Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. CONCLUSION ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.
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Affiliation(s)
- Sneha Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
| | - Anagha Rajeev Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Saurabh Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Soyaf A Phajlani
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
- Department of Radiology, Government Medical College, Nagpur, 440009, India
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Gudu W. Isolated ovarian tuberculosis in an Immuno- competent woman in the post partum period: case report. J Ovarian Res 2018; 11:97. [PMID: 30466448 PMCID: PMC6249878 DOI: 10.1186/s13048-018-0472-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/15/2018] [Indexed: 12/05/2022] Open
Abstract
Background Pelvic tuberculosis is a rare form of extrapulmonary tuberculosis. It commonly involves the fallopian tubes and the uterus from a lympho-hematogeneous spread. The presentation of pelvic tuberculosis as an isolated ovarian abscess is extremely rare and is reported only twice. Case presentation a 25 yrs. old para III mother in the post partum period undergone laparotomy for suspected tuboovarian abscess/ovarian tumor after presenting with abdominal pain, pelvic mass and fever. Intra-operatively, Isolated right ovarian mass with caseation in the cavity but no significant pelvic adhesions was detected and right oophorectomy was done. Post operative Histopathology of surgical specimens revealed tuberculous leision and patient recovered well after anti-tuberculosis treatment. Conclusion Isolated ovarian tuberculosis is a very rare form of Genital Tuberculosis which should always be considered in the evaluation of a woman presenting with any adnexal mass in highly prevalent areas.
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Affiliation(s)
- Wondimu Gudu
- Department of Obstetrics & Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 1271, Addis Ababa, Ethiopia.
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36
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Krishnamurthy G, Rajendran J, Sharma V, Kumar H, Singh H. Incidental peritoneal tuberculosis: surgeon's dilemma in endemic regions. Ther Adv Infect Dis 2018; 5:97-102. [PMID: 30224953 PMCID: PMC6136118 DOI: 10.1177/2049936118783687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/29/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Peritoneal tuberculosis has varying clinical manifestations. The study was conducted to highlight the entity of incidental peritoneal tuberculosis. Diagnostic and therapeutic dilemma is likely to occur on detection of unexpected peritoneal nodules. MATERIALS AND METHODOLOGY Incidental peritoneal tuberculosis was defined as peritoneal tuberculosis (peritoneal tubercles or ascites) detected intraoperatively in patients undergoing surgical exploration for other indications with no preoperative suspicion of abdominal tuberculosis or active tubercular lesions anywhere in the body. Retrospective analysis of patients operated in our department from June 2016 to November 2017 was performed. RESULTS Of the 409 patients operated, 5 patients (1.2%) had incidental peritoneal tuberculosis. The primary indication of surgery was laparoscopic cholecystectomy in three, restoration of bowel continuity in one and laparoscopic appendectomy in one. Two patients had remote history of antitubercular therapy for pulmonary and nodal tuberculosis, respectively. The three patients planned for laparoscopic cholecystectomy had their procedures deferred on suspicion of peritoneal carcinomatosis. Subsequently, all the three underwent cholecystectomy after completion of antitubercular treatment. None of the resected specimen (gallbladder/appendix/colon) had evidence of tuberculosis (acid fast bacilli positive or caseating granuloma). Antitubercular treatment for 6 months was completed in all the patients with active peritoneal disease. CONCLUSION Incidental peritoneal tuberculosis represents an uncommon form of peritoneal tuberculosis. Absence of prior tuberculosis does not preclude the diagnosis of peritoneal tuberculosis. In an endemic region of tuberculosis, surgeons must be aware of the entity on encountering such finding. Frozen section can help in guiding appropriate management.
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Affiliation(s)
- Gautham Krishnamurthy
- Department of General Surgery, Postgraduate
Institute of Medical Education & Research, Chandigarh, India
| | - Jayapal Rajendran
- Department of General Surgery, Postgraduate
Institute of Medical Education & Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate
Institute of Medical Education & Research, Chandigarh, India
| | - Hemanth Kumar
- Department of General Surgery, Postgraduate
Institute of Medical Education & Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate
Institute of Medical Education & Research, Sector-12, Chandigarh 160012,
India
- Department of General Surgery, Postgraduate
Institute of Medical Education & Research, Chandigarh, India
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37
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Weledji EP, Pokam BT. Abdominal tuberculosis: Is there a role for surgery? World J Gastrointest Surg 2017; 9:174-181. [PMID: 28932351 PMCID: PMC5583525 DOI: 10.4240/wjgs.v9.i8.174] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/17/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
It is important that surgeons are familiar with the various manifestations of tuberculosis (TB). Although TB has been declining in incidence in the developed world, it remains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
| | - Benjamin Thumamo Pokam
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
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38
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Inayat F, Jafar MS, Ali NS, Hussain Q, Hurairah A. Enigma of Extrapulmonary Tuberculosis: Where Do We Stand? Cureus 2017; 9:e1554. [PMID: 29021926 PMCID: PMC5633262 DOI: 10.7759/cureus.1554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay its diagnosis and treatment. The present study illustrates the importance of ruling out extrapulmonary tuberculosis in patients presenting with nonspecific symptoms of abdominal diseases. Furthermore, we discuss the variety of clinical presentations, diagnostic challenges, current therapeutic protocols, and prognostic factors associated with extrapulmonary tuberculosis. Early diagnosis and effective treatment may decrease morbidity and mortality in such patients.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, NY, USA
| | - Munnam S Jafar
- Department of Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan
| | - Nouman Safdar Ali
- Department of Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan
| | - Qulsoom Hussain
- Department of Medicine, Shifa International Hospital, Shifa College of Medicine, Islamabad, Pakistan
| | - Abu Hurairah
- Division of Gastroenterology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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40
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Kentley J, Ooi JL, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha MA, Kunst H. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health 2017; 22:994-999. [PMID: 28609809 DOI: 10.1111/tmi.12908] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country. METHOD Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital. RESULTS Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology. CONCLUSION Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
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Affiliation(s)
- J Kentley
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - J L Ooi
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - J Potter
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Tiberi
- Department of Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T O'Shaughnessy
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - L Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Chin Aleong
- Department of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Thaha
- Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - H Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Clinical and laboratory presentation of abdominal tuberculosis in Shillong, Meghalaya: Experience from Northeast India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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42
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Terras Alexandre A, Raimundo S, Pinto C. Peritoneal tuberculosis - A rare diagnosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:172-173. [PMID: 28291709 DOI: 10.1016/j.rppnen.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/22/2017] [Accepted: 02/08/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Terras Alexandre
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal.
| | - S Raimundo
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | - C Pinto
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
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43
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Chung JJ, Choi JM, Cho ES, Kim JH, Yu JS. Multidetector CT findings of histopathologically proven peritoneal tuberculous cold abscesses. Radiol Med 2017; 122:248-256. [PMID: 28110370 DOI: 10.1007/s11547-017-0726-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the characteristic multidetector CT findings of peritoneal tuberculous (TB) cold abscesses. PATIENTS AND METHODS The morphological characteristics of 48 peritoneal TB cold abscesses in 29 patients (male:female = 13:16; age range 16-75 years) were retrospectively evaluated. TB infection was histologically proven by acid fast bacilli (AFB) smear or culture, TB-polymerase chain reaction (PCR), or histopathological specimen diagnosis. RESULTS Seventeen abscesses (35.4%) were present in the right perihepatic space, 10 (20.8%) in the left subphrenic space, 6 (12.5%) in the right subphrenic space, 4 (8.3%) in the pelvic cavity, 3 (6.3%) in the left perihepatic space, 3 (6.3%) in the right lower quadrant, and so on. The abscess contents ranged from 10.4 to 61.4 Hounsfield units. Internal septa (64.6%), central necrotic lymphadenopathy (55.2%), and TB coinfections in other organs (65.5%) were observed. TB infection was histopathologically confirmed from the surgical specimens in 17 patients and other 4 patients revealed the positive TB-PCR results from the peritoneal fluid. Ten patients (34.5%) had a recent history of TB peritonitis with ascites. CONCLUSION Peritoneal TB cold abscesses were commonly found in the right perihepatic and subphrenic spaces and revealed higher density of internal content, frequent internal septa, central necrotic lymphadenopathy, and high TB coinfections in other organs.
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Affiliation(s)
- Jae-Joon Chung
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
| | - Jeong Min Choi
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Eun-Suk Cho
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Joo Hee Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Jeong-Sik Yu
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
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Shreshtha S, Ghuliani D. Abdominal tuberculosis: A retrospective analysis of 45 cases. Indian J Tuberc 2016; 63:219-224. [PMID: 27998492 DOI: 10.1016/j.ijtb.2016.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
Abdominal tuberculosis is defined as infection of the peritoneum, hollow or solid abdominal organs with Mycobacterium tuberculosis. The peritoneum and the ileocaecal region are the most likely sites of infection and are involved in the majority of the cases by haematogenous spread or through swallowing of infected sputum from primary pulmonary tuberculosis. Pulmonary tuberculosis is apparent in less than half of the patients. Patients usually present with abdominal pain, and the cause is usually identified through a combination of radiologic, endoscopic, microbiologic, histologic and molecular techniques. Anti-microbial treatment is the same as for pulmonary tuberculosis. Surgery is occasionally required.
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Affiliation(s)
- Suruchi Shreshtha
- Assistant Professor, General Surgery, Dr Baba Saheb Ambedkar Medical College & Hospital, Delhi, India.
| | - Deepak Ghuliani
- Associate Professor, General Surgery, Maulana Azad Medfical College, Delhi, India.
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Chiappini E, Lo Vecchio A, Garazzino S, Marseglia GL, Bernardi F, Castagnola E, Tomà P, Cirillo D, Russo C, Gabiano C, Ciofi D, Losurdo G, Bocchino M, Tortoli E, Tadolini M, Villani A, Guarino A, Esposito S. Recommendations for the diagnosis of pediatric tuberculosis. Eur J Clin Microbiol Infect Dis 2016; 35:1-18. [PMID: 26476550 DOI: 10.1007/s10096-015-2507-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 10/07/2015] [Indexed: 01/10/2023]
Abstract
Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease.
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Chen CH, Chou KC, Tsao LC. Intestinal ileus and pneumatosis intestinalis as the major manifestations of tuberculous peritonitis: A diagnostic challenge. ADVANCES IN DIGESTIVE MEDICINE 2016. [DOI: 10.1016/j.aidm.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
GOALS The aim of this study was to retrospectively analyze the clinical, endoscopic, and pathologic features of intestinal tuberculosis (TB). BACKGROUND The prevalence of intestinal TB has been increasing in China. STUDY The clinical, imaging and laboratory examination, endoscopic, and pathologic data of 81 cases of intestinal TB patients were retrospectively analyzed. RESULTS There were 48 male and 33 female cases whose age ranged from 17 to 76 years (mean, 32.4±1.6 y). Fifty-five cases were diagnosed by endoscopic biopsy, and 26 cases by postoperative pathologic examination. The common symptoms were chronic right lower abdominal and periumbilical pain (87.7%), weight loss (80.2%), anemia (64.2%), diarrhea (46.9%), fever (43.2%), diarrhea alternating with constipation (38.3%), and night sweats (30.9%). Purified protein derivative test (51.9%), TB antibody (34.6%), and TB protein chip (40.7%) had lower sensitivity. T-spot test sensitivity was 86.4%. Endoscopic types included ulcerative (52.7%), ulcero-proliferative (27.3%), and proliferative (20.0%) with mucosal hyperemia and edema (87.2%), mucosal erosion (76.4%), patulous ileocecal valve (65.5%), polypoid hyperplasia (58.2%), annular ulcer (52.7%), nodular hyperplasia (45.5%), and luminal stenosis (29.1%). Histopathologic findings were chronic mucosal inflammation (87.3%), ulceration (74.5%), lymphocytic aggregation (69.1%), and granulomatous fusion (58.2%). The presence of caseating granulomas (74.5%) and necrosis (25.5%) was helpful, but not common. CONCLUSIONS The clinical symptoms of intestinal TB are nonspecific. The most common anatomic locations for intestinal TB are the ileocecal valve and cecum. The T-spot test has high sensitivity, and it can be used to support the diagnosis of intestinal TB. The typical endoscopic features are circumscribed intestinal ulcers, and histopathologic findings of biopsy specimens can be also useful in making the diagnosis.
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Lukavetskyy O, Boyko N, Fedorov V, Ogurtsov O, Havrysh Y. Abdominal tuberculosis that masked under the early postoperative septic complications. Int J Surg Case Rep 2016; 28:4-8. [PMID: 27657822 PMCID: PMC5035331 DOI: 10.1016/j.ijscr.2016.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/08/2016] [Accepted: 05/14/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION At the same time even laparoscopic adrenalectomy can become the source or the causing factor of a number of complications. In the following report we present the clinic case of diagnostic complications during postsurgical period of "rapid" development and signs of tuberculosis after laparoscopic adrenalectomy. PRESENTATION OF CASE The patient underwent ultrasonography and CT was found out: the tumor of right adrenal gland. Operational treatment: right laparoscopy adrenalectomy. Pathologistological conclusion: clear cell adenoma. On the fourth day there was a high temperature rise noted 38-39°C. On the 10th day the CT, where there were no signs of free liquid abscess formation. Relaparoscopic: small amount of serous-hemorrhagic liquid in small pelvis, hyperemated peritoneum, in both - left and right liver lobes tight knots of white color. After, the patient still had hyperthermia 38°C. Phthisiatrician consulted the patient and diagnosed abdominal tuberculosis. After six-month treatment the patient in satisfactory condition was discharged home. DISCUSSION But in case of our patient's case such visual diagnostic methods, such as CT and ultrasonography of abdominal cavity appeared to be non-informative in lymph system diagnostics due to the number of reasons.The described clinical case and literature data prove the fact, that crucial in abdominal tuberculosis form management treatment is a diagnostic laparoscopy with tissue biopsy. CONCLUSION Labors, as well as adrenalectomy are possible factors which decrease the immunity and can cause the activation of tuberculosis process. Diagnostic laparoscopy and intraoperative histological tissue study of abdominal cavity are the main points in prescribing diagnosis of abdominal tuberculosis form.
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Affiliation(s)
- Oleksii Lukavetskyy
- Surgery No. 1 Department, Danylo Halytsky Lviv National Medical University Nekrasova Street 4, Lviv,79010, Ukraine.
| | - Nina Boyko
- Surgery No. 1 Department, Danylo Halytsky Lviv National Medical University Nekrasova Street 4, Lviv,79010, Ukraine.
| | - Volodymyr Fedorov
- Surgery No. 1 Department, Danylo Halytsky Lviv National Medical University Nekrasova Street 4, Lviv,79010, Ukraine.
| | - Oleksii Ogurtsov
- Surgery No. 1 Department, Danylo Halytsky Lviv National Medical University Nekrasova Street 4, Lviv,79010, Ukraine.
| | - Yaroslav Havrysh
- Surgery No. 1 Department, Danylo Halytsky Lviv National Medical University Nekrasova Street 4, Lviv,79010, Ukraine.
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Rana S, Farooqui MR, Rana S, Anees A, Ahmad Z, Jairajpuri ZS. The role of laboratory investigations in evaluating abdominal tuberculosis. J Family Community Med 2015; 22:152-7. [PMID: 26392795 PMCID: PMC4558736 DOI: 10.4103/2230-8229.163029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Tuberculosis (TB) continues to be a major health problem in developing countries like India. Abdominal TB is defined as an infection of the peritoneum, or hollow or solid abdominal organs with Mycobacterium tuberculosis (Mtb). The gastrointestinal tract is one of the most frequent sites of extrapulmonary involvement in TB. The present study was undertaken to evaluate the role of laboratory investigations in the diagnosis of abdominal TB. MATERIALS AND METHODS The study was conducted on 300 patients admitted to various departments of our hospital from November 2005 to October 2007. Detailed histories and thorough clinical examinations together with relevant hematological, biochemical, cytological, radiological, and histopathological investigations were carried out in suspected cases of Koch's abdomen. RESULTS Erythrocyte sedimentation rates with positive results were seen in 79.3% patients. Serological test enzyme-linked immunosorbent assay was performed on only 30 patients and was found to be positive for IgG, and IgM in 25 cases with a sensitivity of 83%. Thirteen out of 15 cases were positive for adenosine deaminase done on ascitic fluid. The results of the two patients who underwent Mtb polymerase chain reaction (PCR) were consistent with TB. Out of 21 image-guided fine-needle aspiration cytology (FNAC) cases, 10 (48%) of the positive cases showed caseating necrosis while 7 (33%) had noncaseous necrosis. Stain for acid-fast bacilli (AFB) was performed on all cases and was positive in 42 cases (38.8%). Lymph node biopsy was done in 95% of the cases. CONCLUSIONS Serological investigations have a limited value, while PCR is a highly specific test. Since cost restricts its use, only two patients in our study could afford it. BACTEC is more sensitive and faster than culture techniques for the diagnosis of mycobacterial infections. FNAC is a reliable, cost effective alternative, and 81% diagnostic yield in the present study suggests that ultrasound guidance is a useful tool. Histopathological evaluation with positive AFB staining remains the gold standard for diagnosing abdominal TB. However, although the demonstration of AFB in aspirates and tissue sections is a definitive diagnostic method for TB, the positivity for AFB is variable.
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Affiliation(s)
- Sherwani Rana
- Department of Pathology, Jawarhar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad R. Farooqui
- Department of Surgery, Jawarhar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Safia Rana
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Afzal Anees
- Department of Surgery, Jawarhar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Zuber Ahmad
- Department of Tuberculosis and Respiratory Diseases, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Zeeba S. Jairajpuri
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Abdominal tuberculosis: utility of laparoscopy in the correct diagnosis. J Gastrointest Surg 2015; 19:981-3. [PMID: 25650164 DOI: 10.1007/s11605-015-2753-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/14/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Abdominal tuberculosis is one of the most prevalent form of extra-pulmonary disease, and the diagnosis is difficult because of non-specific clinical features. METHOD We presented a case of a Tunisian woman with cough, nausea, decreased appetite and pelvic-abdominal pain. CT scan showed peritoneal thickening, peritoneal tiny nodules and enlarged mesenteric lymph nodes ascitic fluid. Sputum analysis was negative. Abdominal paracentesis was performed, and no malignant cell was detected. The Ziehl staining revealed a negativity for acid-fast bacilli. RESULTS Diagnostic laparoscopy was performed. Biopsy specimens of peritoneum, liver, omentum and diaphragm showed omental epithelioid granulomas with a centrale caseous necrosis and Langhans giant cells. The patient received anti-tubercular treatment. CONCLUSIONS In case of suspicion of tuberculosis, when bacteriologic and cytologic analysis is negative, laparoscopy with biopsies is helpful for correct diagnosis and appropriate management.
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