Cecal obstruction due to primary intestinal tuberculosis: a case series

Left-Sided Colonic Tuberculosis Presenting as Colonic Stricture: A Rare Presentation of a Common Disease

Gastrointestinal tuberculosis (TB) mainly presents as an ileocecal disease, and colonic TB is more often seen with terminal ileal involvement. Isolated involvement of the descending colon by TB is uncommon and usually presents with chronic colitis. An acute presentation as intestinal obstruction because of tubercular stricture of the descending colon has not been reported. We encountered a young woman who presented with features of acute bowel obstruction. On evaluation, she was diagnosed with a case of descending colon stricture with a provisional diagnosis of malignant colonic stricture. Left hemicolectomy was performed, and histopathology revealed it to be tubercular stricture. Antitubercular therapy was given for 9 months, and she is doing well at follow-up. A differential diagnosis of TB at an unusual location should always be considered even when presented with atypical symptoms, especially for patients from the endemic zone of TB.

Ileocaecal Tuberculosis Presenting with Massive Hematochezia: A Rare Clinical Manifestation

Abdominal pain, diarrhea, weight loss, anorexia, and fever are common symptoms of intestinal tuberculosis, while bleeding from the lumen, intestinal obstruction, perforation, and fistula formation are uncommon presentations in ileocaecal tuberculosis. Here, we present a case of a 33-year-old male with intestinal tuberculosis who initially presented with massive bleeding per rectum.

Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment

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.

Ileocecal and hepatic tuberculosis mimicking a metastatic cecal malignancy: Case report

We wish to highlight that on encountering a suspicious hepatic and a colonic lesion, the possibility of TB should also be kept in mind apart from the obvious possibility of metastasis of a colonic cancer especially in an endemic country like Tunisia.

Gastrointestinal Tuberculosis

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.

Caecal Perforation from Primary Intestinal Tuberculosis in Pregnancy

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of extrapulmonary TB (EPTB) can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. We present a case of caecal TB in pregnancy, which resulted in caecal perforation, a right hemicolectomy, and severe preterm delivery. The aim of this case report is to discuss the diagnosis of extrapulmonary TB, as well as its subsequent management in pregnancy.

An audit of secondary peritonitis at a tertiary care university hospital of Sindh, Pakistan

Objective

Peritonitis is the most common life threatening surgical emergency, which requires urgent surgical intervention and is a significant cause of morbidity and mortality. The objective of this study was to highlight the frequency of secondary peritonitis and to analyze the site and causes of perforation, in our tertiary care setup.

Methods

A retrospective analysis of 311 patients of secondary peritonitis was done from July 2008 to June 2010 at Liaquat University Hospital Jamshoro, Hyderabad, Sindh, Pakistan. All cases found to have peritonitis as a result of perforation of any part of gastrointestinal tract at the time of surgery were included in the study. All cases with either primary peritonitis or that due to anastomotic dehiscence were excluded.

Results

A total of 311 patients were studied. Most of the patients were males (77%) and (89%) were in the third and fourth decades of life. Majority of the patients presented with pain (97%) associated with bowel symptoms. Most common site of perforation was small bowel (ileal 59%, jujenal 2%). In this series, most common risk factor of perforation was typhoid (43%). Ileostomy was the most commonly performed procedure. Overall morbidity was 48.5% and mortality was 17%.

Conclusion

Considering the relatively higher rate of typhoid perforation quoted in this study, it is vital that typhoid fever ought to be eliminated by improved sanitation and immunizing programmes, otherwise surgeons will be confronted with its complications.