1
|
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.
Collapse
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
| |
Collapse
|
2
|
Niamita LF, Bramantono, Daviq M, Rusli M, Arifijanto MV. Partial adhesive small bowel obstruction due to peritoneal tuberculosis HIV/AIDS patient: A case report. Int J Surg Case Rep 2024; 121:109977. [PMID: 38959611 PMCID: PMC11268360 DOI: 10.1016/j.ijscr.2024.109977] [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: 04/28/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Diagnosing peritoneal tuberculosis is challenging due to unspecific clinical manifestations, particularly in immunocompromised patients with HIV/AIDS and tuberculosis infections. PRESENTATION OF CASE An Indonesian man, 26-years-old, complained of mid-abdominal colic and constipation. The patient's present state exhibited symptoms of weakness and paleness, oral candidiasis, a bloated abdomen, palpable discomfort, and shifting dullness. The ascitic fluid analysis showed increased ADA (709 U/L), and detected Mycobacterium tuberculosis using GeneXpert MTB/RIF. Radiographic examination from abdominal x-ray and CT scan revealed a small bowel obstruction. He received intestinal decompression, pain control, intravenous fluid resuscitation, and correction of electrolyte imbalance for small bowel obstruction without any indication for surgical intervention. He also receive first-line ATD for 2 months during intensive phase and 4 months for continuous phase. After a period of 2 weeks following the ATD administration, the patient began taking ARV medication on a daily basis. He showed a good prognosis 6 months following. DISCUSSION The diagnosis of peritoneal tuberculosis is challenging due to its unspecific manifestation and some cases are identified when complications such as small bowel obstruction appear. The ADA test and GenExpert MTB/RIF are useful instruments for promptly diagnosing tuberculosis. It is suggested to use ARV treatment in individuals with HIV/AIDS who have peritoneal tuberculosis, starting 2 weeks following ATD treatments. CONCLUSION Peritoneal tuberculosis with small bowel obstruction and HIV/AIDS infection is a rare case in which early diagnosis and monitoring play an important role in successful treatment.
Collapse
Affiliation(s)
- Laili Fitri Niamita
- Study Program of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
| | - Bramantono
- Division of Tropical Disease and Infection, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Mochammad Daviq
- Study Program of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Musofa Rusli
- Division of Tropical Disease and Infection, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Muhammad Vitanata Arifijanto
- Division of Tropical Disease and Infection, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital Surabaya, Indonesia
| |
Collapse
|
3
|
Ethiraj S, Sahoo AK, Das BM. Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series. Indian J Tuberc 2023; 70:422-429. [PMID: 37968048 DOI: 10.1016/j.ijtb.2023.01.002] [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: 06/19/2022] [Revised: 09/14/2022] [Accepted: 01/11/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Abdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. METHODS This was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. RESULTS A total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. CONCLUSION Abdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.
Collapse
Affiliation(s)
- Suraj Ethiraj
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India.
| | - Ashok Kumar Sahoo
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India
| | - Bhuban Mohan Das
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India
| |
Collapse
|
4
|
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: 0.5] [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.
Collapse
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
| |
Collapse
|
5
|
Shams AH, Niakan MH, Ahadi M, Rasekhinejad M, Sardar Kermani S. Small Bowel Obstruction As a Consequence of Peritoneal Tuberculosis. Bull Emerg Trauma 2022; 10:196-200. [PMID: 36568716 PMCID: PMC9758706 DOI: 10.30476/beat.2021.91273.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 12/27/2022] Open
Abstract
Peritoneal tuberculosis (PTB) is a rare subset of extrapulmonary tuberculosis which account for only 0.5-1% of all cases. PTB diagnosis can be challenging due to nonspecific clinical manifestations. We present a known case of pulmonary tuberculosis that admitted to the surgery ward due to the major complaint of abdominal pain since ten days before admission. In imaging studies, positive findings favoring mechanical obstruction were detected. There were also several hypodense lesions in the liver suggestive of visceral tuberculosis. An adhesion was noted during exploratory laparotomy prior to the ileocecal valve responsible for intestinal obstruction, which was released. Pathology reports of excised tissues were consonant with the PTB diagnosis. PTB diagnosis can be challenging because of its presentation. This can delay the treatment of patients and thus increase morbidity and mortality. As a result, physicians should always be aware of the PTB diagnosis in patients with nonspecific abdominal involvement.
Collapse
Affiliation(s)
- Amir Hossein Shams
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Ahadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Rasekhinejad
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Majid Rasekhinejad Address: Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. e-mail:
| | | |
Collapse
|
6
|
Kalanjati VP, Oktariza RT, Yahya Y, Machin A. Paralytic ileus in the patient with tuberculosis of spine. Br J Neurosurg 2020; 34:602-603. [DOI: 10.1080/02688697.2019.1639621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Viskasari P. Kalanjati
- Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Rury T. Oktariza
- Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Yahya Yahya
- Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Abdulloh Machin
- Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Hospital, Surabaya, Indonesia
| |
Collapse
|
7
|
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: 0.8] [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.
Collapse
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
| |
Collapse
|
8
|
Philip Sridhar R, Coelho VV, Roopavathana B, Chase S. Opportunistic penicilliosis infection causing intestinal obstruction in people living with HIV complicating antiretroviral therapy. BMJ Case Rep 2020; 13:13/2/e230121. [PMID: 32060105 DOI: 10.1136/bcr-2019-230121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a retroviral positive patient who presented to us with recurrent skin lesions along with intermittent, colicky periumbilical abdominal pain associated with non-projectile, postprandial vomiting. Contrast-enhanced CT (CECT) of abdomen and pelvis was suggestive of proximal jejunal obstruction. Double balloon enteroscopy done which showed extensive deep ulceration with surrounding nodular surface and friable mucosa at 60 cm from pylorus with luminal narrowing. The biopsy from this region as well as the skin lesion on the forehead grew Talaromyces marneffei She was initially treated with liposomal amphotericin B for 2 weeks following which she received itraconazole for 3 weeks for disseminated talaromycosis infection. She had already been started on antiretroviral therapy (ART) 1 year back however her cluster of differentiation 4 (CD4) counts did not show any improvement. Proximal bowel obstruction leading to poor nutritional status compounded with ineffective ART therapy due to suboptimal absorption, dictated the staged management of her condition. Feeding jejunostomy was done with a plan to offer her resection and anastomosis of affected jejunal segment, should she require one, after optimising her nutritional and immunological status.
Collapse
Affiliation(s)
| | - Victor Vijay Coelho
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Beulah Roopavathana
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suchita Chase
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
9
|
Poppe M, Peng K, Arnold D. Consumption Junction: A Case of Peritoneal Tuberculosis-induced Small Bowel Obstruction. Clin Pract Cases Emerg Med 2018; 2:51-54. [PMID: 29849271 PMCID: PMC5965140 DOI: 10.5811/cpcem.2017.11.36310] [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] [Received: 09/02/2017] [Revised: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 11/11/2022] Open
Abstract
The rapid diagnosis and treatment of tuberculosis (TB) is necessary to prevent the spread of infection to others and reduce morbidity and mortality. Atypical presentations are not often considered in the differential. This patient presented with fever and abdominal pain. Computed tomography of the abdomen and pelvis showed small bowel obstruction, initially attributed to the patient's Crohn's disease. Chest radiograph showed diffuse interstitial lung disease, consistent with his diagnosis of sarcoidosis. He had multiple recent negative tuberculin skin tests documented. After being admitted to the surgical service and started on antibiotics, the diagnosis of abdominal TB was discovered following surgical exploration and tissue sampling.
Collapse
Affiliation(s)
- Michael Poppe
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - Kelly Peng
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - Dylan Arnold
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| |
Collapse
|
10
|
Mohar SM, Saeed S, Ramcharan A, Depaz H. Small bowel obstruction due to mesenteric abscess caused by Mycobacterium avium complex in an HIV patient: a case report and literature review. J Surg Case Rep 2017; 2017:rjx129. [PMID: 28721191 PMCID: PMC5507249 DOI: 10.1093/jscr/rjx129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/15/2017] [Indexed: 10/26/2022] Open
Abstract
Small bowel obstruction in HIV patients is reportedly caused by inflammatory pseudotumor, Kaposi's sarcoma, cryptococcal lymphadenopathy and intestinal tuberculosis. The incidence of Mycobacterium avium complex (MAC) infection in HIV patients is 3% for CD4 cell count of 100-199 /mm3. MAC causing small bowel obstruction is rarely reported in the literature. We report a rare case of MAC causing mesenteric abscess with small bowel obstruction in a HIV patient with a CD4 cell count of 144 /mm3. Patient was a 35-year-old HIV-positive male on highly active antiretroviral therapy who presented with partial small bowel obstruction secondary to mesenteric abscess. He underwent operative intervention for drainage with cultures growing MAC.
Collapse
Affiliation(s)
- S M Mohar
- Department of Surgery, Harlem Hospital Columbia University Medical Center, 506 Lenox Ave., New York, NY 10037, USA
| | - Saqib Saeed
- Department of Surgery, Harlem Hospital Columbia University Medical Center, 506 Lenox Ave., New York, NY 10037, USA
| | - Alexius Ramcharan
- Department of Surgery, Harlem Hospital Columbia University Medical Center, 506 Lenox Ave., New York, NY 10037, USA
| | - Hector Depaz
- Department of Surgery, Harlem Hospital Columbia University Medical Center, 506 Lenox Ave., New York, NY 10037, USA
| |
Collapse
|
11
|
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: 6.3] [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.
Collapse
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
| |
Collapse
|
12
|
Chaparro JMO, Reyes-Ortiz CA, Soto R, Reynolds JW. Abdominal tuberculosis presenting as ascites in an older indigenous woman: a case report. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Mauricio Ocampo Chaparro
- Jefe del Servicio de Hospitalización Geriátrica programa ‘Siéntete como en Casa’ Corporación Comfenalco-Universidad Libre; Profesor Asociado, Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Division of Geriatric and Palliative Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Ramiro Soto
- Especialista Medicina Familiar, Universidad del Cauca, Popayán, Colombia
| | | |
Collapse
|
13
|
Maharaj N, Singh B. A review of the radiological imaging modalities of non-traumatic small bowel obstruction. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.977052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
14
|
|
15
|
Wasim Yusuf N, Iqbal S, Sarfraz R, Khalid Sohail S, Imran M. Spectrum of pathologies in cases of intestinal obstruction & perforation based on histopathological examination of resected intestine - Report from a third world country. Pak J Med Sci 2014; 30:373-9. [PMID: 24772146 PMCID: PMC3999013 DOI: 10.12669/pjms.302.5050] [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: 11/05/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Objective: Cases presenting with intestinal perforation and obstruction constitute a substantial work load on our surgical service. Etiologies vary in underdeveloped and developed countries. Histopathological examination of resected intestine is expected to provide the definite evidence of the underlying etiology- guiding a better health care planning for preventive measures. Our objective was to study the spectrum of histopathological findings in resected intestines from cases of intestinal obstruction and perforation in our local population to document the underlying etiology. Methods: A total of 120 cases of intestinal resection were included. Detailed gross and microscopic examination with routine stains was performed. Definite evidence of any specific etiology on the basis of morphology was documented. Results: A total of 95 cases with clinical/radiological diagnosis of obstruction (79.2%) and 25 of intestinal, perforation (20.8%) were included. Tuberculous enteritis was the commonest etiology (n=41; 43.1%) in cases of intestinal obstruction followed by malignant tumours (n=30; 31.5%). ischemic infarct/gangrene, post op illeal adhesions, polyps and ulcerative colitis followed. In cases of perforation, Typhoid enteritis (n=15; 60%), was the commonest pathology followed by idiopathic perforation (n=5; 20%), tuberculous enteritis (n=3;12%), carcinoma (4%) and ulcerative coliti (4%). Conclusion: In developing countries infective etiology remains a dominant cause of intestinal obstruction and perforation. Its presentation in younger age leading to intestinal resection demands effective preventive measures in this part of the world to prevent morbidity and mortality.
Collapse
Affiliation(s)
- Noshin Wasim Yusuf
- Noshin Wasim Yusuf, Head and Professor, Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan
| | - Sehr Iqbal
- Sehr Iqbal, Lecturer, Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan
| | - Rahat Sarfraz
- Rahat Sarfraz, Associate Professor, Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan
| | - Shezada Khalid Sohail
- Shezada Khalid Sohail, Consultant Histopathologist, Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan
| | - Mohammad Imran
- Mohammad Imran, Consultant Histopathologist, Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan
| |
Collapse
|