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Cheng W, Zhang S, Li Y, Wang J, Li J. Intestinal tuberculosis: clinico-pathological profile and the importance of a high degree of suspicion. Trop Med Int Health 2018; 24:81-90. [PMID: 30338607 DOI: 10.1111/tmi.13169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wei Cheng
- Department of General Surgery; Jinling Hospital; Medical School of Nanjing University; Nanjing China
| | - Shaoyi Zhang
- Department of General Surgery; Shanghai Ninth People's Hospital; Shanghai JiaoTong University School of Medicine; Shanghai China
| | - Yousheng Li
- Department of General Surgery; Shanghai Ninth People's Hospital; Shanghai JiaoTong University School of Medicine; Shanghai China
| | - Jian Wang
- Department of General Surgery; Jinling Hospital; Medical School of Nanjing University; Nanjing China
| | - Jieshou Li
- Department of General Surgery; Jinling Hospital; Medical School of Nanjing University; Nanjing China
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2
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Fry DE. Extra-Pulmonary Tuberculosis and Its Surgical Treatment. Surg Infect (Larchmt) 2016; 17:394-401. [DOI: 10.1089/sur.2016.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Donald E. Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Zhao J, Cui MY, Chan T, Mao R, Luo Y, Barua I, Chen M, Li ZP, Feng ST. Evaluation of intestinal tuberculosis by multi-slice computed tomography enterography. BMC Infect Dis 2015; 15:577. [PMID: 26695641 PMCID: PMC4688963 DOI: 10.1186/s12879-015-1325-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 12/14/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multi-slice computed tomography enterography (MSCTE) is now widely used to diagnose and monitor intestinal disease. Preliminary studies suggest that MSCTE may be useful in detecting intestinal tuberculosis (ITB). We sought to assess the use of MSCTE for the diagnosis of ITB in our medical center. METHODS In this retrospective study, 15 patients (11 males and 4 females, 6 to 65 years old) were enrolled and diagnosed with ITB by MSCTE. Diagnosis were confirmed by pathology or clinical criteria. Two experienced abdominal radiologists evaluated the images and defined the location, number, shape, edge, surrounding tissue alterations of ITB and other associated changes in the peritoneum, mesentery and solid abdominal organs. RESULTS The interval between the onset of symptoms and diagnosis varied from 20 days to 10 years. The most common symptom was abdominal pain (80 %). The ileocecum was the most common site affected by ITB (87 %). Morphological MSCTE findings were variable and included multi-segmental symmetric intestinal mural thickening found in 6 patients (40 %), solid masses found in 9 patients (60 %), and enlarged lymph nodes (LNs) found in 13 (87 %) patients. Non-enhancing central necrosis and rim enhancement were noted in 10 patients (67 %). CONCLUSIONS Characteristic MSCTE findings of ITB include solid mass or multi-segmental symmetric mural thickening involving the ileocecal area and rim enhanced LNs. Knowledge of these features in combination with a high index of suspicion can be useful in early diagnosis of ITB.
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Affiliation(s)
- Jing Zhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Min-Yi Cui
- Department of Radiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Tao Chan
- Medical Imaging Department, Union Hospital, Hong Kong. 18 Fu Kin Street, Tai Wai, Shatin, NT, Hong Kong.
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Indira Barua
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University. 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
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da Rocha EL, Pedrassa BC, Bormann RL, Kierszenbaum ML, Torres LR, D'Ippolito G. Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings. Radiol Bras 2015; 48:181-91. [PMID: 26185345 PMCID: PMC4492571 DOI: 10.1590/0100-3984.2013.1801] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 04/25/2014] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis is a disease whose incidence has increased principally as a consequence
of HIV infection and use of immunosuppressive drugs. The abdomen is the most common
site of extrapulmonary tuberculosis. It may be confused with several different
conditions such as inflammatory bowel disease, cancer and other infectious diseases.
Delay in the diagnosis may result in significantly increased morbidity, and therefore
an early recognition of the condition is essential for proper treatment. In the
present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed
by means of computed tomography and magnetic resonance imaging, demonstrating the
involvement of different organs and systems, and presentations which frequently lead
radiologists to a diagnostic dilemma. A brief literature review was focused on
imaging findings and their respective prevalence.
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Affiliation(s)
- Eduardo Lima da Rocha
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Bruno Cheregati Pedrassa
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Renata Lilian Bormann
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Marcelo Longo Kierszenbaum
- MDs, Radiologists at Unit of Abdomen, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Lucas Rios Torres
- Fellow, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Professor at Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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5
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Lee KJ, Yoo JS, Jeon H, Cho SK, Lee JH, Ha SS, Cho MY, Kim JW. A Case of Splenic Tuberculosis Forming a Gastro-splenic Fistula. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 66:168-71. [DOI: 10.4166/kjg.2015.66.3.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kyong Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Sae Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hosung Jeon
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Kook Cho
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Sam Ha
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mee Yon Cho
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Woo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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6
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Law ST, Chiu SC, Li KK. Intestinal tuberculosis complicated with perforation during anti-tuberculous treatment in a 13-year-old girl with defective mitogen-induced IL-12 production. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 47:441-6. [PMID: 22841619 DOI: 10.1016/j.jmii.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/16/2012] [Accepted: 06/06/2012] [Indexed: 01/01/2023]
Abstract
Interleukin-12 (IL-12) is a cytokine which is secreted by activated phagocytes and dendritic cells and promotes cell-mediated immunity to intracellular pathogens, by inducing type 1 helper T cell (TH1) responses and interferon- γ (IFN- γ) production. Defects in the IL-12 may cause selective susceptibility to intracellular pathogens, such as mycobacteria. We herein report on a 13-year-old girl with defective mitogen-induced IL-12 production, who developed intestinal tuberculosis with wide dissemination involving the lung and urinary tract. She improved gradually, but developed terminal ileal perforation approximately 6.1 months following initiation of anti-tuberculous treatment. The paradoxical response phenomenon was suspected. The girl subsequently underwent surgical resection of the affected bowel segment with a temporary double barrel stoma, and ileocolonic anastomosis was performed after the completion of the anti-tuberculous therapy. The patient remained well, with no evidence of recurrent tuberculosis in the past 5 years. This case illustrates the possibility of underlying primary immunodeficiency in a patient with disseminated tuberculosis; delayed tuberculous intestinal perforation can develop during chemotherapy for tuberculosis.
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Affiliation(s)
- Siu-Tong Law
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
| | - Sin-Chuen Chiu
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Kin Kong Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-67. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [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: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Affiliation(s)
- I Ashkenazi
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel.
| | - O Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - B Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - M M Krausz
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
| | - R Alfici
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
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8
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Lower gastrointestinal tract tuberculosis: an important but neglected disease. Int J Colorectal Dis 2009; 24:1175-80. [PMID: 19421759 DOI: 10.1007/s00384-009-0721-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE Difficulties in early and accurate diagnosis of intestinal tuberculosis lead to frequent misdiagnosis even in endemic areas. This study aimed to investigate clinical and laboratory characteristics of patients with lower gastrointestinal tract tuberculosis (LGITB). MATERIALS AND METHODS Patients who met the criteria for LGITB in a medical center from 1997 to 2006 were identified and their medical records reviewed. RESULTS A number of 4,567 patients with culture or histology-proven tuberculosis were identified, and 30 (0.66%) were diagnosed with LGITB. Principal co-morbidities were type II diabetes mellitus (23%) and alcoholism (23%). Twenty-two (73%) had radiographic findings suggestive of pulmonary tuberculosis, which was culture-proven in 13. Mycobacterial cultures from stool or sputum had diagnostic yields of about 50%, comparable to that of histological studies of colonoscopic or surgical biopsies. Multidrug-resistant tuberculosis (MDRTB) was identified in four patients, including two alcoholics. Fourteen underwent surgery; two (14%) received right hemicolectomy under the diagnosis of colon cancer without pre- or intraoperative histological study. The 1-year mortality was 20% but was 50% in patients with MDRTB. CONCLUSIONS A high rate of alcoholism and diabetes mellitus and a high percentage of MDRTB among alcoholics were observed in our patients with LGITB. The diagnostic yields of stool or sputum mycobacterial culture (50%) were similar to that of intestinal histological study. Pre- or intraoperative histological examination could prevent unnecessarily extensive surgery.
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Nakamura S, Yanagihara K, Izumikawa K, Seki M, Kakeya H, Yamamoto Y, Miyazaki Y, Suyama N, Kohno S. Severe pulmonary tuberculosis complicating Ileocecal intussusception due to intestinal tuberculosis: a case report. Ann Clin Microbiol Antimicrob 2008; 7:16. [PMID: 18620597 PMCID: PMC2478653 DOI: 10.1186/1476-0711-7-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 07/13/2008] [Indexed: 03/12/2023] Open
Abstract
Adult intussusception is a rare clinical entity that is most often caused by a tumor, such as a lipoma, adenoma, or malignant tumor. A case of adult intussusception due to intestinal tuberculosis of the ileocecal region is reported. There are few cases of intussusception due to intestinal tuberculosis.
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Affiliation(s)
- Shigeki Nakamura
- Second Department of Internal Medicine, Nagasaki University Graduate School of Medical Science, Nagasaki, Japan.
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Abstract
OBJECTIVE Reports suggest that the rates of tuberculosis (TB) continue to rise in the UK and throughout the world. The spread of the disease is aided by poverty, overcrowding, co-infection with human immunodeficiency virus and drug resistance. Consistent with the overall trend, intra-abdominal and gastrointestinal (GI) TB rates are rising. Tuberculosis is a treatable disease, whether occurring in the lungs or at extra-pulmonary sites but the nonspecific features of the disease result in difficulty in establishing a diagnosis. In this report, we have concentrated on the benefits and potential pitfalls of diagnostic methods. METHOD A literature review was performed using the National Library of Medicine's Pubmed Database using the keywords diagnosis, management, abdominal and GI TB. RESULTS Abdominal TB presents a particular challenge, as the diverse features of the disease do not readily suggest a particular diagnosis and diagnostic delays lead to significant morbidity and mortality. A number of investigative methods have been used to aid in the diagnosis of abdominal and GI TB. CONCLUSION The nonspecific presentation of abdominal and GI TB present challenges in the diagnosis of this increasingly common disease. A high index of suspicion is an important factor in early diagnosis. After a diagnosis has been established, prompt initiation of treatment helps prevent morbidity and mortality.
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Affiliation(s)
- S Rasheed
- St Mark's Hospital, Harrow, Middlesex, UK
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Rakotoarisoa B, Rakoto Ratsimba HN, Rantomalala YH, Wagner JD, Andriamanarivo L, Ratiambahoaka G, Ramonja JM. Fistulisation vésicale d'une tuberculose sigmoïdienne. Arch Pediatr 2006; 13:1236-8. [PMID: 16824740 DOI: 10.1016/j.arcped.2006.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
A sigmoid tuberculosis is very rare. We report a case of sigmoid pseudotumoral tuberculosis with a fistulization into the urinary bladder in a 10-year-old girl. The diagnosis of tuberculosis was made by histopathological examination of the surgical specimen after segmental colectomy. Surgery completed by antitubercular chemotherapy gave a good result.
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Affiliation(s)
- B Rakotoarisoa
- Service de chirurgie viscérale et digestive, CHU d'Antananarivo, BP 1275, 101 Antananarivo, Madagascar.
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Abstract
The authors present a case of intestinal tuberculosis affecting exclusively the left colon causing severe undernourishment, abdominal pain, and bowel obstruction with a sealed colonic fistula in a 10-year-old child. These clinical characteristics and difficulties led to a diagnosis of intestinal tuberculosis in childhood. Intestinal tuberculosis affecting exclusively the colon is very rare, and differential diagnosis with Crohn's disease is difficult. Surgical complications are frequent, especially intestinal obstruction, and can be treated in most cases by resection of the affected segment and primary anastomosis.
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