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

Abstract

BACKGROUND

Mycobacterium tuberculosis (TB) is the causative agent of TB, a chronic granulomatous illness. This disease is prevalent in low-income countries, posing a significant global health challenge. Gastrointestinal TB is one of the three forms. The disease can mimic other intra-abdominal conditions, leading to delayed diagnosis owing to the absence of specific symptoms. While gastric outlet obstruction (GOO) remains a frequent complication, its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy. Gastroduodenal TB can cause upper gastrointestinal hemorrhage, obstruction, and malignancy-like tumors.

CASE SUMMARY

A 23-year-old male presented with recurrent epigastric pain, distension, nausea, vomiting, and weight loss, prompting a referral to a gastroenterologist clinic. Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation. However, treatment was interrupted, possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes. Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall. Resection revealed gastric wall effacement with TB.

CONCLUSION

Primary gastric TB is rare, frequently leading to GOO. Given its rarity, suspicions should be promptly raised when encountering relevant symptoms, often requiring surgical intervention for diagnosis and treatment.

Keywords: Tuberculosis; Gastrointestinal tuberculosis; Gastric outlet obstruction; Gastroduodenal tuberculosis; Case report

Core Tip: Tuberculosis (TB) is a disease that has been around since ancient times and is still one of the top 10 causes of death globally. With a high incidence in lower-income countries. It is a global health concern, with gastrointestinal TB The third most common extrapulmonary form of TB. Here we present Primary gastroduodenal TB presenting as gastric outlet obstruction (GOO): A case report and review of the literature. The diagnosis of abdominal TB is often delayed since there are no distinct clinical signs and symptoms, and the disease can mimic other intra-abdominal pathologies. The most common causes of GOO include peptic ulcer disease and gastric cancer. TB should be included ddx when these dx is excluded. Surgery is inevitable when GOO is present at time of diagnosis and proceed by antitubercular treatment.