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Shukla R, Warrier R, Sharma N, Kumar K, Arora S, Singh N. Eosinophilic gastroenteritis as an uncommon cause of ascites recurrence in a young female. Med J Armed Forces India 2023; 79:S283-S287. [PMID: 38144619 PMCID: PMC10746740 DOI: 10.1016/j.mjafi.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022] Open
Abstract
Ascites appear as a clinical manifestation of various disorders, and the presence of raised levels of eosinophils in the peritoneal fluid characterizes eosinophilic ascites, which is an extremely rare disorder. Eosinophilic gastroenteritis is one of the uncommon causes of ascites. If not investigated thoroughly, ascites recurrence in a young female with a history of tuberculosis may be wrongly attributed to tuberculosis recurrence in an endemic country. The etiology of ascites in our case was correctly identified as the subserosal form of eosinophilic ascites. Oral corticosteroids form the mainstay of treatment in such cases. Eosinophilic gastroenteritis is a rare disease, but a thorough workup and a strong clinical suspicion may help in the successful diagnosis and treatment of such cases.
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Affiliation(s)
- Rajat Shukla
- Commandant, Military Hospital Namkum, Ranchi, India
| | - Rachana Warrier
- Graded Specialist (Internal Medicine), Military Hospital Namkum, Ranchi, India
| | - Neeraj Sharma
- Graded Specialist (Respiratory Medicine), Military Hospital Namkum, Ranchi, India
| | - Kunal Kumar
- Graded Specialist (Respiratory Medicine), Military Hospital Namkum, Ranchi, India
| | - Sumeet Arora
- Senior Advisor & Head (Radiology), Military Hospital Namkum, Ranchi, India
| | - Nalin Singh
- Graded Specialist (Pathology), Military Hospital Namkum, Ranchi, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Choudhury A, Dhillon J, Sekar A, Gupta P, Singh H, Sharma V. Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review. BMC Gastroenterol 2023; 23:246. [PMID: 37468869 DOI: 10.1186/s12876-023-02887-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
Gastrointestinal Tuberculosis (GITB) and Crohn's disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of the developed world. But in recent times, the epidemiology of both diseases has changed. Differentiating GITB from CD is of immense clinical importance as the management of both diseases differs. While GITB needs anti-tubercular therapy (ATT), CD needs immunosuppressive therapy. Misdiagnosis or a delay in diagnosis can lead to catastrophic consequences. Most of the clinical features, endoscopic findings, and imaging features are not pathognomonic for either of these two conditions. The definitive diagnosis of GITB can be clinched only in a fraction of cases with microbiological positivity (acid-fast bacilli, mycobacterial culture, or PCR-based tests). In most cases, the diagnosis is often based on consistent clinical, endoscopic, imaging, and histological findings. Similarly, no single finding can conclusively diagnose CD. Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, radiology, and serology have been used to differentiate GITB from CD with varied results. However, it is limited by the lack of validation studies for most such models. Many patients, especially in TB endemic regions, are initiated on a trial of ATT to see for an objective response to therapy. Early mucosal response assessed at two months is an objective marker of response to ATT. Prolonged ATT in CD is recognized to have a fibrotic effect. Therefore, early discrimination may be vital in preventing the delay in the diagnosis of CD and avoiding a complicated course.
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Affiliation(s)
| | | | - Aravind Sekar
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Harjeet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Dass M, Kaur M, Aittan S, Sharma P, Punia S, Muthumohan R, Anthwal D, Gupta RK, Mahajan G, Kumari P, Sharma N, Taneja RS, Sharma LK, Shree R, Tyagi JS, Lal V, Haldar S. MPT51 and MPT64-based antigen detection assay for the diagnosis of extrapulmonary tuberculosis from urine samples. Diagn Microbiol Infect Dis 2023; 107:115973. [PMID: 37348159 DOI: 10.1016/j.diagmicrobio.2023.115973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
In view of WHO's "End-TB" strategy, we developed a non-invasive, urine-based ELISA, targeting 2 Mycobacterium tuberculosis antigens namely MPT51 and MPT64 for extrapulmonary TB (EPTB) diagnosis. Suspected EPTB patients (n = 137) [Pleural TB, Abdominal TB and Tuberculous meningitis] were categorized in "Definite" EPTB (n = 10) [Xpert-MTB/RIF and/or culture-positive], "Probable" EPTB (n = 77) and "Non-EPTB" (n = 50) groups using defined composite reference standards. ROC-curves were generated using ELISA results of "Definite" EPTB and "Non-EPTB" groups for both antigens independently and cut-off values were selected to provide 86.3% (95%CI:73.3-94.2) specificity for MPT51 and 92% (95%CI:80.8-97.8) for MPT64. The sensitivity of MPT51-ELISA and MPT64-ELISA was 70% (95%CI:34.7-93.3) and 90% (95%CI:55.5-99.7) for "Definite" EPTB group and 32.5% (95%CI:22.2-44.1) and 30.8% (95%CI:20.8-42.2) for "Probable" EPTB group, respectively. Combining the results of both ELISAs showed a 100% (95%CI:69.1-100) sensitivity in "Definite" EPTB group and 41.6% (95%CI:30.4-53.4) in "Probable" EPTB group, with an 80% (95%CI:66.3-89.9) specificity. The results demonstrated the potential of urine-based ELISAs as screening tests for EPTB diagnosis.
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Affiliation(s)
- Manisha Dass
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohinder Kaur
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Simran Aittan
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Sharma
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Punia
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajagopalan Muthumohan
- Centre for Biodesign and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India
| | - Divya Anthwal
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh K Gupta
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gargi Mahajan
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Kumari
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajesh S Taneja
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Lokesh K Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ritu Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaya S Tyagi
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sagarika Haldar
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Centre for Biodesign and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India.
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Matondang SBRE, Wibowo TA, Hilmy IA, Siregar TP, Yonathan IWM. Isolated pancreatic tuberculosis with splenic tuberculosis mimicking lymphoma malignum: A case report. Radiol Case Rep 2023; 18:1775-8. [PMID: 36926537 DOI: 10.1016/j.radcr.2023.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Tuberculosis is an endemic disease in certain parts of the world. This disease typically presents in the lungs, but it may also appear within the abdomen, such as in the pancreas. There can be challenges in diagnosing isolated pancreatic tuberculosis as it may mimic other diseases radiologically. We present a 33-year-old female with intermittent abdominal pain and weight loss. Chest x-rays showed normal findings while noncontrast abdominal computed tomography (CT) showed a solid cystic mass in the pancreas and in the spleen. Contrast-enhanced CT showed an inhomogeneous cystic mass in the body and tail of the pancreas with peripheral rim enhancement. A laparotomy procedure was performed, and tuberculosis was confirmed histopathologically. In this case report, we highlight the challenging nature of diagnosing isolated pancreatic and splenic tuberculosis due to its presentation, which is similar to other neoplastic processes.
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Anand A, Nagpal A, Arsia A, Ahuja A. Rare cause of intussusception in a young male with a new possible etiology - A case report. Int J Surg Case Rep 2023; 106:108204. [PMID: 37119754 PMCID: PMC10173147 DOI: 10.1016/j.ijscr.2023.108204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Inflammatory Fibroid Polyp (IFP) is a rare benign tumor of the gastrointestinal tract with no proven etiology. IFPs may sometimes produce complications like intussusception when present in the small bowel. This is a case report of a patient with an established diagnosis of inflammatory fibroid polyp with abdominal tuberculosis. Such co-existence has not been reported yet in literature. CASE PRESENTATION In this case report we see a 22-year-old gentleman presenting with a 10-day history of generalized abdominal pain which then progressed to obstipation. X-ray abdomen findings were consistent with small bowel obstruction. Computerized tomography imaging revealed the presence of a Jejuno-ileal intussusception. The patient was taken up for emergency laparotomy and he underwent resection of the intussuscepted segment with a polyp found as the lead point accompanied by dense bowel adhesions. Histopathological examination revealed it to be a Benign Fibro epithelial Polyp. Histopathology of the resected bowel segment and mesenteric lymph node also revealed findings confirmatory of abdominal tuberculosis. This may be a possible new etiology of the fibro epithelial polyp and this co-existence has never been reported before in literature. CONCLUSION Tuberculosis may be a possible inciting factor for the development of benign fibro epithelial polyp in the small bowel which may in turn lead to complications such as small bowel intussusception warranting need for surgical intervention.
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Affiliation(s)
- Arti Anand
- Lady Hardinge Medical College, New Delhi 110001, India.
| | | | - Ashish Arsia
- Department of Surgery, Lady Hardinge Medical College, New Delhi 110001, India
| | - Arvind Ahuja
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi 11001, India
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Griffith A, Trabue C. You Have Gut TB Kidding Me. J Community Hosp Intern Med Perspect 2023; 13:30-2. [PMID: 36817298 DOI: 10.55729/2000-9666.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 01/11/2023] Open
Abstract
Tuberculosis is a disease that affects millions of individuals worldwide every year.1 Most cases present as pulmonary tuberculosis, though there are rare reports of abdominal tuberculosis. These presentations make up only 1-3% of all tuberculosis cases worldwide.1 Symptoms are often vague, presenting as abdominal pain, discomfort, or weight changes.2 These symptoms can be misdiagnosed for other more common gastrointestinal disorders. Unfortunately, misdiagnosis or a prolongation in diagnosis can lead to worsened patient outcome due to delay of initiation of anti-tubercular therapy.3 It is therefore imperative that providers understand the spectrum of symptoms associated with this illness as well as having a high clinical suspicion for patients at risk. Incorporating this knowledge and using a thorough diagnostic work up to confirm this disease is crucial, as delay of care can lead to poor patient prognosis or death.3.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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
- grid.415131.30000 0004 1767 2903Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ritin Mohindra
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Kirtan Rana
- grid.415131.30000 0004 1767 2903Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pardhu B. Neelam
- grid.415131.30000 0004 1767 2903Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dhuni Chand Thakur
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harjeet Singh
- grid.415131.30000 0004 1767 2903Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Gupta
- grid.415131.30000 0004 1767 2903Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vikas Suri
- grid.415131.30000 0004 1767 2903Department 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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Jha DK, Pathiyil MM, Sharma V. Evidence-based approach to diagnosis and management of abdominal tuberculosis. Indian J Gastroenterol 2023; 42:17-31. [PMID: 36899289 PMCID: PMC10005918 DOI: 10.1007/s12664-023-01343-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/20/2023] [Indexed: 03/12/2023]
Abstract
Abdominal tuberculosis is an ancient problem with modern nuances in diagnosis and management. The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB), while the less frequent forms are esophageal, gastroduodenal, pancreatic, hepatic, gallbladder and biliary tuberculosis. The clinicians need to discriminate the disease from the close mimics: peritoneal carcinomatosis closely mimics peritoneal tuberculosis, while Crohn's disease closely mimics intestinal tuberculosis. Imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and occasionally positron emission tomography) guide the line of evaluation. Research in diagnostics (imaging and endoscopy) has helped in the better acquisition of tissue for histological and microbiological tests. Although point-of-care polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) may provide a quick diagnosis, these have low sensitivity. In such situations, ancillary investigations such as ascitic adenosine deaminase and histological clues (granulomas, caseating necrosis, ulcers lined by histiocytes) may provide some specificity to the diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered if all diagnostic armamentaria fail to clinch the diagnosis, especially in TB-endemic regions. Objective evaluation with clear endpoints of response is mandatory in such situations. Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for early response assessment and should be sought at two months. Biomarkers, especially fecal calprotectin for intestinal tuberculosis, have also shown promise. For most forms of abdominal tuberculosis, six months of ATT is sufficient. Sequelae of GITB may require endoscopic balloon dilatation for intestinal strictures or surgical intervention for recurrent intestinal obstruction, perforation or massive bleeding.
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Affiliation(s)
| | | | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
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Puri A, Khairong PDS, Singh S. A Critical Appraisal of Clinicopathological, Imaging, and GeneXpert Profiles of Surgical Referrals with Pediatric Abdominal Tuberculosis. J Indian Assoc Pediatr Surg 2023; 28:41-47. [PMID: 36910283 PMCID: PMC9997595 DOI: 10.4103/jiaps.jiaps_195_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/08/2022] [Accepted: 07/30/2022] [Indexed: 03/14/2023] Open
Abstract
Aim To study the clinicopathological, imaging, and GeneXpert profiles of surgical referrals with abdominal tuberculosis (TB) and to compare the utility of GeneXpert versus conventional diagnostic armamentarium. Materials and Methods This cohort study which was conducted over a study period of 8 years (2011-18) included seventy-seven children operated with a provisional diagnosis of abdominal TB and those who had either histological (n = 58; 75.3%) or GeneXpert (n = 9) confirmation or had miliary tubercles on exploration with supportive clinical and imaging findings (n = 17; 22.1%). GeneXpert testing was added to the diagnostic armamentarium only in the latter half of the study (2016-18, n = 31). Demographic details, symptomatology, prior antitubercular treatment, GeneXpert positivity, imaging, operative, and histological findings were recorded and analyzed using mean, standard deviation, and range for continuous variables and proportion for categorical variables. Results Perforation peritonitis (n = 26; 33.8%) and unrelieved obstruction (n = 51; 66.2%) were the main surgical indications. The mean age at presentation was 9.5 ± 3.6 years with a distinct female preponderance. The presence of right lower abdomen lump (n = 23; 29.9%), alternate diarrhea and constipation (n = 34; 44.1%), tubercular toxemia (n = 38; 49.4%), positive history of contact (n = 20; 25.9%), tuberculin positivity (n = 38; 49.4%), fibrocavitary pulmonary lesion (5.2%), clumped bowel loops with pulled-up cecum (n = 23; 29.9%), septated ascites (n = 17), mesenteric lymphadenopathy and omental thickening (n:18; 23.4% each) were the supportive tell-tale signs of the disease. The hallmark of pathological diagnosis was caseous necrosis with epithelioid granulomas (n = 43; 55.8%), nongranulomatous caseation (n = 15; 19.5%), and acid-fast bacilli positivity in 27.3% of patients. GeneXpert was positive in only nine patients with an overall sensitivity of 29% as compared to 75.3% for histopathology. Conclusion Bacteriological and histological confirmation of the disease eluded us in a significant proportion of patients, requiring a very high index of clinical suspicion to clinch the diagnosis. The current version of GeneXpert has low sensitivity in diagnosing pediatric abdominal TB.
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Affiliation(s)
- Archana Puri
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Peter Daniel S. Khairong
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Smita Singh
- Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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Liu PG, Chen XF, Feng PF. Rectal cancer combined with abdominal tuberculosis: A case report. World J Clin Cases 2022; 10:11523-11528. [PMID: 36387825 PMCID: PMC9649531 DOI: 10.12998/wjcc.v10.i31.11523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/29/2022] [Accepted: 09/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is very rare to suffer from colorectal adenocarcinoma and abdominal tuberculosis simultaneously. Even in a country such as China, where tuberculosis is still endemic, its diagnosis and treatment are challenging. This article describes in detail a case of rectal cancer complicated by abdominal tuberculosis and its pathological features.
CASE SUMMARY We outline the case of a 71-year-old female who was admitted with intermittent blood in the stool over the past year. The patient was diagnosed with low rectal cancer and received neoadjuvant therapy. The patient then returned to the hospital for surgery, but diffusely distributed nodules were found during laparoscopic exploration. The diagnosis of rectal cancer with extensive metastasis was considered during the operation. There was no opportunity for radical surgery. Thus, nodules were taken for pathological examination, and the abdomen was closed. The histopathological diagnosis was tuberculous granuloma, and the patient was treated with standardized anti-tuberculosis drugs in a specialized hospital. Later, the patient again came to our hospital and underwent abdominoperineal resection. She was discharged 10 d after the operation in good clinical condition.
CONCLUSION We aim to emphasize the importance of preoperative and postoperative pathological examination in diagnosis and treatment.
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Affiliation(s)
- Pei-Gen Liu
- Department of General Surgery, Central Hospital of Panzhihua City, Panzhihua 617000, Sichuan Province, China
| | - Xiang-Fan Chen
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Pan-Feng Feng
- Department of Pharmacy, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
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Kumar P, Jena A, Birda CL, Singh H, Gupta P, Prasad KK, Dutta U, Sharma V. Safety and efficacy of non-fluoroscopic endoscopic dilatation of gastrointestinal tuberculosis related strictures. BMC Gastroenterol 2022; 22:60. [PMID: 35148672 PMCID: PMC8832754 DOI: 10.1186/s12876-022-02140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/04/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce. Methods A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients. Results Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn’s disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1–5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons. Conclusion Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.
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Affiliation(s)
- Pankaj Kumar
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anuraag Jena
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chhagan Lal Birda
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harjeet Singh
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kaushal Kishor Prasad
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Usha Dutta
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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:
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14
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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,Address for correspondence: Dr. M. K. Shariff, King Abdullah Medical City, PO Box 57657, Makkah Al Mukaramah - 21955, Kingdom of Saudi Arabia. E-mail:
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15
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Barot M, Yagnik VD, Patel K, Dawka S. Surgical management of abdominal tuberculosis: A prospective single-center study. Tzu Chi Med J 2020; 33:282-287. [PMID: 34386367 PMCID: PMC8323646 DOI: 10.4103/tcmj.tcmj_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Tuberculosis (TB) can affect any part of the gastrointestinal tract. It is estimated that in 2018, 10 million people were affected with TB worldwide and there were 1.2 million TB deaths among human immunodeficiency virus-negative people. India has the highest TB burden in the world (27%), a significant proportion of which are of intestinal TB. The aims of this study were to assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and its management. Materials and Methods From October 1, 2014, to October 30, 2016, a total of 50 patients meeting the inclusion criteria for the study, age between 15 and 65 years and diagnosis of symptomatic intestinal TB requiring surgery, were enrolled in the study. We used descriptive statistics to analyze the data. Results Abdominal TB was most commonly seen in young adults. Intestinal obstruction was the most frequent presentation. The most common site of involvement in the present study was the ileum. Ultrasonography (USG) and X-ray were an integral part of the diagnosis, with computed tomography (CT) scan being rarely required. Although both anemia and erythrocyte sedimentation rate (ESR) are nonspecific, they may help in supporting the clinical and pathological findings. Most operations were elective, with intestinal obstruction being the most common indication and resection and end-to-end anastomosis performed most often. Histopathological examination was performed in all patients and showed caseating granuloma in 90% of cases, while 10% of cases had chronic noncaseating granulomas with ill-defined aggregates of epithelioid histiocytes. Conclusion Abdominal TB causes a significant problem in diagnosis due to nonspecific symptomatology and lack of specific laboratory tests. USG and X-ray were an integral part of the diagnosis. CT scan is rarely required. Although anemia and ESR are both nonspecific features, they may help in supporting the clinical and pathological findings. The most common site of involvement in the present study was the ileum. Intestinal obstruction was the most common indication for operation, with resection and end-to-end anastomosis being the most common operation. The mainstay of treatment is medical therapy and timely surgical intervention is required in a sizable number of patients.
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Affiliation(s)
- Mithun Barot
- Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Vipul D Yagnik
- Department Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
| | - Kirankumar Patel
- Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
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Abstract
BACKGROUND The diagnosis of gallbladder tuberculosis remains elusive even to the most experienced clinicians. Our aim is to describe our experience of this rare disease, and to raise awareness of the increasing likelihood of tuberculosis in chronic kidney disease (CKD) patient. CASE PRESENTATION We report a rare case of gallbladder tuberculosis in a chronic kidney disease patient on hemodialysis. This combination is rarely reported in literature. No signs of abdominal tuberculosis were observed besides a clinical profile consistent with CKD in our patient. The clinical signs of uremia masks those of abdominal tuberculosis and render the pre-operative diagnosis of tuberculosis more difficult. CONCLUSIONS The clinical signs of uremia conceal those of abdominal tuberculosis. The diagnosis of tuberculosis in CKD patients hinges mainly on a high index of suspicion, perioperative findings and histological examination.
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Affiliation(s)
- Tewodross Getu Wolde
- The First Affiliated Hospital of Nanjing Medical University, School of International Education, Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Abstract
Background Abdominal tuberculosis is an uncommon variant of extrapulmonary tuberculosis. It accounts for 3.5% of extrapulmonary tuberculosis. Diagnosis of abdominal tuberculosis is still a challenge due to its non-specific symptoms. Abdominal tuberculosis and ovarian cancer may show similar symptoms, laboratory and imaging features. The goal of our report is to emphasize for the need of a diagnostic approach based on clinical manifestations, laboratory, imaging findings, and additional tests for considering a diagnosis of abdominal tuberculosis rather than ovarian cancer. Case presentation We report 3 cases of abdominal tuberculosis in our Onco-gynaecology Division, Department of Obstetrics and Gynaecology, Sardjito Hospital, Yogyakarta, Indonesia in 2018 which were previously diagnosed as ovarian malignancy and managed surgically. All of our patients experienced abdominal pain and enlargement but only two of them had significant weight loss. The general symptoms were typically found in onco-gynaecology patients, especially in those with ovarian malignancy. Ultrasound examination showed multilocular masses, 2 of them with solid parts and ascites. Cancer antigen 125 (CA-125) levels were found increasing in those three patients. All of them were treated surgically and diagnosis of abdominal tuberculosis was established through the histopathological result of tissue biopsy. Based on our cases and literature, we consider the need of a diagnostic approach to differentiate abdominal tuberculosis from ovarian malignancy, an attempt to avoid unnecessary invasive procedures that put burden risk for the patients. Conclusion Minimally invasive tests to establish the diagnosis of abdominal tuberculosis should be optimized to reduce the burden risk of laparotomy. Careful diagnostic steps should be followed to avoid wrong diagnosis.
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Affiliation(s)
- Moh Nailul Fahmi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
| | - Annisaa Pelita Harti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
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Gong Y, Li S, Rong R, Chen X, Jiang L. Isolated gastric varices secondary to abdominal tuberculosis mimicking lymphoma: a case report. BMC Gastroenterol 2019; 19:78. [PMID: 31138138 PMCID: PMC6540571 DOI: 10.1186/s12876-019-0998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Abdominal tuberculosis (TB) rarely presents with abdominal masses and rarely causes isolated gastric varices. Case presentation We report a case of isolated gastric varices secondary to abdominal TB mimicking lymphoma. A 42-year-old woman without any history of liver disease presented with melena and mild abdominal pain. Upon admission to the hospital, laboratory investigations revealed a hemoglobin level of 76 g/L. Gastroduodenoscopic examination showed isolated gastric fundal varices with red color signs. Abdominal contrast-enhanced computed tomography (CECT) revealed non-enhanced masses of soft-tissue density in the lesser omental and the retropancreatic areas, multiple para-aortic lymph nodes, and multiple small hypodense splenic lesions. Positron emission tomography-CT showed hypermetabolic [F-18]2-fluoro-2-deoxyglucose activity involving multiple regional lymph nodes and the bone marrow, suggestive of lymphoma. Bone marrow biopsy revealed no abnormality. Histopathological examination of a CT-guided biopsy specimen showed granulomatous inflammation with necrosis and microorganisms that stained positive with acid-fast stains. Abdominal CECT showed a decrease in the size of the lesser omental and peripancreatic masses, as well as the para-aortic lymph nodes after 4-month anti-TB therapy. Conclusions TB should be considered among the differential diagnoses in patients with abdominal masses, isolated gastric varices, and regional lymphadenopathy. Prompt and definitive diagnosis of abdominal TB requires a coordinated approach involving laboratory tests, radiological examination, and invasive procedures for optimal decision making and management.
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Affiliation(s)
- Yaoyao Gong
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Shuo Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Rong Rong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Xiaoxing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China.
| | - Liuqin Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
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Zheng S, Shafi H. Pneumoperitoneum during treatment of abdominal tuberculosis in a Non-HIV patient: Natural progression or paradoxical worsening? Int J Mycobacteriol 2019. [PMID: 29516894 DOI: 10.4103/ijmy.ijmy_191_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paradoxical reactions during tuberculosis (TB) treatment are well-described in the HIV seropositive population but less so in the HIV seronegative group. Abdominal TB rarely presents as spontaneous perforation; cases occurring during anti-TB therapy are even rarer. We describe the clinical progress of a case of an HIV-negative patient who developed acute peritonitis while on anti-TB treatment for peritoneal TB through a series of clinical, radiological and histological images. Visceral perforation can occur as a complication of TB treatment. A high index of suspicion with early surgical intervention is crucial in the management of such cases.
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Affiliation(s)
- Shuwei Zheng
- Division of Infectious Diseases, Changi General Hospital, Singapore
| | - Humaira Shafi
- Division of Infectious Diseases, Changi General Hospital, Singapore
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20
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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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Soni H, Bellam BL, Rao RK, Kumar PM, Mandavdhare HS, Singh H, Dutta U, Sharma V. Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis. Infection 2019; 47:387-94. [PMID: 30324229 DOI: 10.1007/s15010-018-1235-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of adjunctive steroids in abdominal tuberculosis is unclear. OBJECTIVE To evaluate effect of adjunctive use of steroids for abdominal tuberculosis in reducing/preventing complications. METHODS We searched electronic databases (Medline, Embase, CENTRAL, Scopus, Web of Science, CINAHL) from inception to 25th June 2018 using the terms "abdominal tuberculosis" OR "intestinal tuberculosis" OR "peritoneal tuberculosis" OR "tuberculous peritonitis" AND steroids OR methylprednisolone OR prednisolone. Bibliography of potential articles was also searched. We included studies comparing adjunctive steroids to antitubercular therapy (ATT) alone. We excluded non-English articles, case reports, reviews and unrelated papers. The primary outcome was a comprehensive clinical outcome including need for surgery or the presence of symptomatic stricture (abdominal pain or intestinal obstruction). Quality assessment of included studies was done using ROBINS-I tool. Random-effects model was used to calculate the summary effect for all the outcomes. RESULTS Of total 633 records, three studies on peritoneal tuberculosis were included in meta-analysis. These papers were of poor quality (one quasi-randomised study and two retrospective cohort studies). Meta-analyses showed adjunctive steroids, with ATT is more effective than ATT alone in tuberculous peritonitis patients for the prevention of composite end point (RR 0.15 [0.04, 0.62], p = 0.008), symptomatic stricture(RR 0.15 [0.04-0.62] p = 0.008) and intestinal obstruction (RR 0.18 [0.03-0.99] p = 0.05). CONCLUSION The data on use of steroids for abdominal tuberculosis are limited to peritoneal tuberculosis. Although steroids seem to have some benefit in patients of tubercular peritonitis, the poor quality of studies limits the generalisability of the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42016047347.
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Zhu LB, Zhang YY, Li JQ, Li PF, Zhang PB, Jin JW. Treatment of an incarcerated inguinal hernia associated with abdominal tuberculosis in an adult patient. J Int Med Res 2018; 46:3474-3479. [PMID: 30019613 PMCID: PMC6134657 DOI: 10.1177/0300060518786628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of tuberculosis is increasing worldwide, especially in developing countries. The prevalence of abdominal tuberculosis has been found to be as high as 12% in people with extrapulmonary tuberculosis. Peritoneal thickening and intestinal adhesions can occur in patients with abdominal tuberculosis. Inguinal hernias are extremely rare in people with abdominal tuberculosis; only 11 cases have been reported in the English-language literature, half of which involved pediatric patients. No definitive guideline on the management of such cases is available. In this report, we describe the unusual finding of an incarcerated inguinal hernia in an adult with abdominal tuberculosis and propose a therapy to treat this complicated disease based on our successful experience.
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Affiliation(s)
- Lin-Bo Zhu
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Yuan-Yan Zhang
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Jun-Qiang Li
- 2 Department of Pathology, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Peng-Fei Li
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Peng-Bin Zhang
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
| | - Jia-Wei Jin
- 1 Department of General Surgery, Beilun District People's Hospital, Ningbo, Zhejiang, China
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Gandhi S, Arora E, Bhandarwar A, Patil A, Wagh A, Gupta S. When a cure becomes the pathology: mechanical bowel obstruction due to herbal pharmacobezoar. A case report with review of literature. Clin J Gastroenterol 2018; 11:396-400. [PMID: 29680980 DOI: 10.1007/s12328-018-0861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/14/2018] [Indexed: 10/17/2022]
Abstract
Bezoars are intra-luminal concretions of ingested material which accumulate within the bowel. They are termed pharmacobezoars when the constituent material is drugs. We report a 64-year-old female with abdominal pain and obstipation for 3 days. Patient had completed anti-tuberculous combination therapy for suspected abdominal tuberculosis 25 years ago. She exhibited features of shock with a right iliac fossa lump. Abdominal X-ray displayed multiple air-fluid levels with densely cluttered radio-opacities in the right lower quadrant. Laparotomy revealed a palpable mid-ileal intra-luminal lump, adherent to the ascending colon and proximal ileum necessitating resection. Ex vivo examination of resected specimen revealed numerous tablets aggregating proximal to an ileal stricture. The patient post-operatively confirmed the tablets resembled the herbal laxatives she had been consuming. Pharmacobezoars can lead to subacute intestinal obstruction. Numerous drugs have been implicated. Patients with partial gastrectomy and vagotomy are at risk. CT is the pre-eminent diagnostic modality. The treatment options for pharmacobezoars include lavage, endoscopic retrieval, in addition to surgery. Pharmacobezoars need a high index of suspicion for pre-operative diagnosis. A detailed history and correlation with radioimaging can offer important cues. One can prevent pharmacobezoars by abstaining from unwarranted medications and identifying those at risk.
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Khan RA, Wahab S, Ghani I. Does diverting ileostomy improve the outcome in children with tuberculous small bowel obstruction requiring surgical intervention? Pediatr Surg Int 2017; 33:1215-1219. [PMID: 28956144 DOI: 10.1007/s00383-017-4169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Abdominal tuberculosis is fairly common in children. The most common clinical presentation is bowel obstruction. Depending upon the presentation, the intestinal obstruction can be either managed conservatively or by operative intervention. There are various options in patients who undergo operative treatment. This study was undertaken to analyze the results of operative intervention with and without ileostomy. MATERIALS AND METHODS This is a retrospective study carried out over a period of 10 years on 32 children who were operated for small bowel obstruction due to abdominal tuberculosis. The patients were divided into two groups (A: with ileostomy and B: without ileostomy). The relevant data and the defined outcome measures were statistically analyzed. RESULTS A total of 32 children with tuberculous bowel obstruction requiring surgical intervention were studied. The patient of group A had mean duration of postoperative ileus for 2.55 days, restoration of enteral feeding within mean period of 3.55 days and had a primary hospital stay for a mean period of 9.0 days. These outcomes when compared with group B patients were statistically significant. CONCLUSION In children with bowel obstruction due to tuberculosis, diverting ileostomy decreases the morbidity by allowing early return of enteral motility, early institution of feeding and first-line ATT and decreasing the primary hospital stay.
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Affiliation(s)
- Rizwan Ahmad Khan
- Department of Pediatric Surgery, J. N. Medical College, AMU, Aligarh, UP, India
| | - Shagufta Wahab
- Department of Radiodiagnosis, J. N. Medical College, AMU, Aligarh, UP, India.
| | - Imran Ghani
- Department of Pediatric Surgery, J. N. Medical College, AMU, Aligarh, UP, India
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Natarajan V, John K, Jose D, Kalaiselvan P, Das AK. Portal Venous Thrombosis-Disseminated Tuberculosis in Rheumatoid Arthritis. J Clin Diagn Res 2017; 11:OD08-OD10. [PMID: 28764227 DOI: 10.7860/jcdr/2017/27640.10048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/11/2017] [Indexed: 11/24/2022]
Abstract
Vascular thrombosis is one of the complications of tuberculosis. Deep vein thrombosis and pulmonary thrombosis have been reported with pulmonary and extrapulmonary tuberculosis. Splenic involvement in abdominal tuberculosis is among the rarest manifestations. Disseminated tuberculosis is predominantly reported in rheumatoid arthritis following ingestion of biological agents. Here, we report a case of disseminated tuberculosis in a rheumatoid arthritis patient who was on steroids and methotrexate for a long period, presenting with multiple splenic lesion and portal vein thrombosis, which was not reported earlier. She was treated with antitubercular drugs, anticoagulants and showed improvement.
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Affiliation(s)
- Vasanthi Natarajan
- Associate Professor, Department of Medicine-Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Kevin John
- Senior Resident, Department of Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - David Jose
- Assistant Professor, Department of Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Pradeep Kalaiselvan
- Senior Resident, Department of Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Ashok Kumar Das
- Professor, Department of Medicine-Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, India
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Kumar B, Upadhyaya VD, Rahul SK, Bharti LK, Rao RN, Kumar S. Acute presentation of koch's abdomen in children: Our experience. Afr J Paediatr Surg 2017; 14:43-48. [PMID: 29557350 PMCID: PMC5881285 DOI: 10.4103/ajps.ajps_91_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To analyse our experience with acute presentations of abdominal tuberculosis (TB) in children for early diagnosis and management. MATERIALS AND METHODS From December 2010 to April 2016, available electronic and operation theatre (OT) records of 17 patients with confirmed diagnosis of abdominal TB were analysed retrospectively. Parameters reviewed were age, sex, presentations, diagnostic investigations, surgery/intervention performed, final outcome and follow-up. RESULTS Out of 17 patients, 6 (35.3%) were already operated elsewhere. The duration of symptoms ranged from 4 to 58 weeks. Abdominal pain was present in all cases whereas 11 (64.7%) had abdominal distension, 16 (94.1%) fever, 14 (82.3%) ascites, 9 (52.9%) vomiting, 14 (82.3%) weight loss, 6 (35.3%) anorexia and 4 (23.5%) night sweat. All patients needed surgical intervention for definitive diagnosis. Thirteen (76.5%) out of 17 patients managed by staged surgery and primary anastomosis/repair/adhesiolysis were done in 4 (23.5%) patients. The main post-operative problems were wound infections (8; 47.1%), subacute bowel obstruction (6; 35.3%) and chest infections (12; 70.6%). Follow-up period ranged from 3 months to 5.5 years. CONCLUSION Abdominal TB should always be considered in differential diagnosis in children presenting with abdominal pain/distension, fever and ascites or with abdominopelvic mass. Recurrent bowel obstruction or anastomotic disruptions also give clues of its diagnosis. A careful history of illness, high index of suspicion, ascitic fluid adenosine deaminase or polymerase chain reaction for Mycobacterium needed for early diagnosis. Prompt minimal surgical interventions, preferred diversion over primary anastomosis, algorithmic vigilant post-operative care and early antitubercular treatment required for success in acute crisis.
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Affiliation(s)
- Basant Kumar
- Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vijai Dutta Upadhyaya
- Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Kumar Rahul
- Department of Pediatric Surgical Superspeciality, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Laxmi Kant Bharti
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ram Nawal Rao
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sheo Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ngonge AL, Ekaney DSM, Sama CB, Musonge-Effoe J, Effoe VS, Ekwen G. Multiple jejunal perforation secondary to intestinal tuberculosis infection: a case report. Pan Afr Med J 2017; 27:78. [PMID: 28819499 PMCID: PMC5554641 DOI: 10.11604/pamj.2017.27.78.11061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/16/2017] [Indexed: 11/15/2022] Open
Abstract
Abdominal tuberculosis (TB) may affect any part of the gastrointestinal tract resulting in significant morbidity and mortality. There is an increase in the incidence of abdominal TB favored by the emergence of multi-drug resistant Mycobacterium tuberculosis and immunosuppression especially from HIV co-infection. Our case is that of a 31 year old HIV-positive woman, adherent to antiretroviral therapy, who presented with a 2 month history of progressive abdominal distention, drenching night sweat and fatigue, but without fever. She was admitted on a presumptive diagnosis of peritoneal TB, and suddenly developed signs and symptoms of an acute abdomen. Laboratory investigations showed a CD4+ count of 155 cells/µL, white blood cell count of 15,700 cells/mm3 and haemoglobin of 8.0g/dl. An emergency laparotomy revealed small bowel caseous necrosis with multiple jejunal perforations. Ziehl-Nelsen staining of operative specimen was positive for acid fast bacilli. Given her immunodeficiency status, clinical signs and symptoms, CD4 cell count > 50 cells/µL, and intestinal sample showing caseous necrosis and perforations, a final diagnosis of intestinal TB was made. In conclusion, abdominal tuberculosis may mimic a number of intra-abdominal pathologies; thus should always be considered as a differential diagnosis in patients presenting with acute abdomen in TB-endemic areas especially in an HIV-positive individual.
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Affiliation(s)
- Anthony Lyonga Ngonge
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Department of Surgery, Baptist Hospital Mutengene, Cameroon
| | - Domin Sone Majunda Ekaney
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Department of Surgery, Baptist Hospital Mutengene, Cameroon
| | - Carlson-Babila Sama
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Bambalang Medicalised Health Centre, Northwest Cameroon and Galactic Corps Research Group(GCRG), Buea, Cameroon
| | | | - Valery Sammah Effoe
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Gerald Ekwen
- Department of Surgery, Baptist Hospital Mutengene, Cameroon
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Albano D, Treglia G, Desenzani P, Bertagna F. Incidental Unilateral Tuberculous Sacroiliitis Detected by 18F-FDG PET/CT in a Patient with Abdominal Tuberculosis. Asia Ocean J Nucl Med Biol 2017; 5:144-147. [PMID: 28660225 PMCID: PMC5482919 DOI: 10.22038/aojnmb.2017.8634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tuberculosis is a systemic disease which involves skeletal and articular system very rarely. Osteoarticular tuberculosis commonly occurs in the vertebral column and more rarely in the sacroiliac joints. In this study, we report a 44-years-old male patient with low-grade fever, malabsorption syndrome, abdominal and pelvic ascites and low-back pain, that underwent 18F-FDG PET/CT for identifying the cause of signs and symptoms after a negative abdominal CT and negative thorax radiography. The study revealed increased tracer uptake at the peritoneal ascites and at the right sacroiliac joint in absence of bone alteration suggesting a sacroiliitis. Staining of the ascitic fluid was positive for acid-fast bacilli (Ziehl-Neelsen) and in the subsequent abdominal paracentesis Mycobacterium Tuberculosis was isolated; the final diagnosis was abdominal tuberculosis with a sacroiliac joint involvement. The patient started antitubercular therapy for 6 months and the clinical conditions were resolved, in particular both back pain and ascites disappeared.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy,Corresponding author: Domenico Albano, University of Brescia and Spedali Civili Brescia, Brescia, Italy. Tel: +39303995468; Fax: +39303995420;
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Paolo Desenzani
- Division of Internal Medicine, Montichiari Hospital, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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Abstract
BACKGROUND Diagnosis of abdominal tuberculosis (TB) from ascitic fluid samples using routinely available diagnostic methods is challenging due to its paucibacillary nature. Although performance of Xpert MTB/RIF assay has been evaluated extensively on pulmonary samples, its performance on extrapulmonary samples is still under evaluation. OBJECTIVES The objective of this study was to find out the performance of Xpert MTB/RIF on ascitic fluid samples obtained from suspected cases of abdominal TB. Performance was compared with Mycobacterium growth indicator tube-960 (MGIT-960) culture and in-house multiplex polymerase chain reaction (PCR). The latter detects and differentiates Mycobacterium tuberculosis and nontuberculous mycobacteria simultaneously. MATERIALS AND METHODS Sixty-seven patients suspected of probable/possible abdominal TB were included in this observational, prospective study. All samples were tested by Ziehl-Neelsen staining, MGIT-960 culture, in-house multiplex PCR, and Xpert MTB/RIF assay. RESULTS All 67 samples were smear negative. Seventeen (25.4%) were MGIT-960 culture positive while 12 (17.9%) were detected positive by the Xpert MTB/RIF assay and 9 (13.4%) by in-house multiplex PCR. Sensitivity and specificity of the Xpert MTB/RIF assay compared with the MGIT-960 culture were 70.6% (95%, confidence interval [CI]: 44.1-89.7) and 100% (95%, CI: 92.8-100) and that of in-house multiplex PCR were 52.9% (95%, CI: 30.9-73.8) and 100% (95%, CI: 92.8-100), respectively. CONCLUSIONS Diagnostic yield of Xpert MTB/RIF assay on ascitic fluid samples was lower than MGIT-960 culture. We thus emphasize on the need for urgent discovery of new biomarkers for paucibacillary TB.
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Affiliation(s)
- Syed Beenish Rufai
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Prof. Sarman Singh, E-mail:
| | - Amit Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parveen Kumar
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jitendra Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Vishal
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, PGIMER, New Delhi, India
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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sood I, Kasundra GM, Supriya PS, Gupta A, Bhushan B. A rare case of occult abdominal tuberculosis with Poncet's disease mimicking Adult onset Still's disease. J Midlife Health 2015; 6:125-8. [PMID: 26538990 PMCID: PMC4604672 DOI: 10.4103/0976-7800.165593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 50-year-old female presented with fever, symmetrical arthralgias, rash, painful oral ulcerations and alopecia since 8 weeks. Examination showed mild hepatospleenomegaly. Investigations revealed leucocytosis, neutrophilia, elevated sedimentation rate and raised ferritin levels (3850 ng/ml). Computerized tomography (CT) abdomen showed hepatospleenomegaly, mild ascitis and mild bilateral pleural-effusion. After ruling out occult infections, tuberculosis, malignancies and autoimmune diseases by appropriate investigations, and due to raised ferritin levels, adult onset stills disease (AOSD) was diagnosed. Patient responded to oral steroids initially, but after 7 days developed severe abdominal pain. Repeat CT showed multiple enlarged, necrotic and matted retroperitoneal lymph nodes with caseating granuloma on histopathology suggesting tuberculosis. Patient was given four-drug anti-tubercular treatment and she improved. Thus our patient of occult abdominal tuberculosis with reactive arthritis (Poncet's disease) presented with hyperferritinemia mimicking AOSD. We postulate that extreme hyperferritinemia can be seen in tuberculosis and tuberculosis must be conclusively ruled out before diagnosing AOSD in tropics.
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Affiliation(s)
- Isha Sood
- Department of Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Gaurav M Kasundra
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | | | - Aradhana Gupta
- Department of Pathology, Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Bharat Bhushan
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
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Malik R, Srivastava A, Yachha SK, Poddar U, Lal R. Childhood abdominal tuberculosis: Disease patterns, diagnosis, and drug resistance. Indian J Gastroenterol 2015; 34:418-25. [PMID: 26678593 DOI: 10.1007/s12664-015-0582-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Childhood abdominal tuberculosis may be difficult to diagnose with certainty. Drug resistance adds to the challenge. We present our experience in children with this condition. METHODS The case records of all children <18 years of age and diagnosed as abdominal tuberculosis from January 2000 to April 2012 were reviewed. The clinical details; investigative profile (imaging, ascitic fluid analysis, upper gastrointestinal (GI) endoscopy, colonoscopy, and laparotomy); histopathology; microbiology; and response to antitubercular therapy was noted. RESULTS Thirty-eight children (median age 11, range 4-16 years) were diagnosed. Multiple intraabdominal sites were involved in 12 (32 %), peritoneal alone in 9 (24 %); isolated intestinal and isolated lymph nodal in 6 (16 %) each. Three children had atypical presentations with gastric outlet obstruction, acute lower GI bleeding, and duodenal perforation, respectively. Overall, definitive bacteriological diagnosis was possible in 47 % (18/38). In others, diagnosis was supported by histopathology (19 %) or other supportive investigations (34 %) along with a response to treatment without relapse. Drug-resistant disease was diagnosed in three (8 %, two multidrug resistant, one extended drug resistant) all of whom presented with a similar clinical picture of large abdominal lymph node masses. CONCLUSION Abdominal tuberculosis is still a challenging diagnosis with microbiological confirmation possible only in half of the cases. Atypical presentations and emergence of drug resistance should be kept in mind while managing these patients.
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Affiliation(s)
- Rohan Malik
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India
| | - Surender K Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India
| | - Richa Lal
- Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India
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Abstract
INTRODUCTION Abdominal tuberculosis (TB) has always been a diagnostic challenge, even for the astute surgeon. In developing countries, extrapulmonary TB often presents as an acute abdomen in surgical emergencies such as perforations and obstructions of the gut. Abdominal TB in different forms has been found more often as an aetiology for the chronic abdomen. This paper aims to evaluate TB as a surgical problem. METHODS A comprehensive review of the literature on abdominal TB was undertaken. PubMed searches for articles listing abdominal TB/different types/diagnosis/treatment (1980-2012) were performed. RESULTS TB is still a global health problem and the abdomen is one of the most common sites of extrapulmonary TB. Presentation may vary from an acute abdomen to a number of different chronic presentations, which can mimic other abdominal diseases. While some may benefit from antitubercular therapy, others may develop surgical problems such as strictures or obstruction, which may necessitate surgical intervention. CONCLUSIONS Abdominal TB should always be considered one of the differential diagnoses of acute or chronic abdomen in endemic areas.
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Affiliation(s)
- S Pattanayak
- Maharaja Krishna Chandra Gajapati Medical College and Hospital , Berhampur, India
| | - S Behuria
- Maharaja Krishna Chandra Gajapati Medical College and Hospital , Berhampur, India
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Abstract
Background: Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population. Aims: The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features. Materials and Methods: In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients. Results: Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals. Conclusion: Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.
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Affiliation(s)
- Waqas Jehangir
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Rafay Khan
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Constante Gil
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Marilyn Baruiz-Creel
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Geraldo Bandel
- Palm Springs General Hospital, Hialeah, Florida, United States
| | - John R Middleton
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Purnendu Sen
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
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Liu M, Wu HC, Li Q. A case of abdominal tuberculosis with regional portal hypertension. Shijie Huaren Xiaohua Zazhi 2015; 23:3001-3004. [DOI: 10.11569/wcjd.v23.i18.3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Regional portal hypertension (RPH) is also known as high pressure in the left side of the portal venous system. The obstruction of the splenic vein increases the venous pressure of the spleen and stomach, resulting in gastric varices, which is the main pathogenesis of RPH. Severe cases can lead to upper gastrointestinal bleeding. Pancreatic disease is the most common cause, however, splenic venous oppression by abdominal tuberculosis (TB) is extremely rare, and is very likely to be misdiagnosed because of atypical TB symptoms. Here we report such a case, hoping to help clinicians to raise their awareness of this rare cause of RPH.
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Ranjan P, Dutta S, Kakkar A, Goyal A, Vikram NK, Sharma MC, Sood R. T-cell lymphoma masquerading as extrapulmonary tuberculosis: case report and review of literature. J Family Med Prim Care 2015; 4:280-3. [PMID: 25949984 PMCID: PMC4408718 DOI: 10.4103/2249-4863.154677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
It is often difficult to establish confirmatory diagnosis in cases of extrapulmonary tuberculosis (TB) because of its paucibacillary nature and difficulty in accessing the involved organs. In several cases, empirical anti-tubercular treatment is started, and the patient is followed-up closely for response. In countries with high prevalence of TB, it is a reasonably good strategy and works most of the times. However, catastrophe may occur when aggressive lymphomas masquerade as TB.
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Affiliation(s)
- Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Dutta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rita Sood
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Gupta N, Dass A, Goel N, Tiwari S. Tuberculous Otitis Media Leading to Sequentialib Bilateral Facial Nerve Paralysis. Iran J Otorhinolaryngol 2015; 27:231-7. [PMID: 26082906 PMCID: PMC4461848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. CASE REPORT The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. CONCLUSION Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications.
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Affiliation(s)
- Nitin Gupta
- Department of Otorhinolaryngology, Govt Medical College and Hospital, Sector-32, Chandigarh, India. ,Corresponding Author: Department of Otorhinolaryngology, Govt Medical College and Hospital, Chandigarh, India. Mob: +919646121704 , E-mail:
| | - Arjun Dass
- Department of Otorhinolaryngology, Govt Medical College and Hospital, Sector-32, Chandigarh, India.
| | - Neha Goel
- Department of Otorhinolaryngology, Govt Medical College and Hospital, Sector-32, Chandigarh, India.
| | - Sandeep Tiwari
- Department of Otorhinolaryngology, Govt Medical College and Hospital, Sector-32, Chandigarh, India.
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N N, Mukherjee A. A rare case of perforation peritonitis with jejunal stricture in a patient recently treated for pulmonary tuberculosis. J Clin Diagn Res 2015; 8:ND07-8. [PMID: 25653991 DOI: 10.7860/jcdr/2014/10802.5346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/14/2014] [Indexed: 11/24/2022]
Abstract
Abdominal tuberculosis (ATB) constitutes 12% of the extra pulmonary disease and is a rare but well-documented cause of perforation peritonitis, occasionally occurring in cases where the diagnosis has been delayed but may occur even after antituberculous therapy has been initiated. Most patients with tuberculosis strictures respond well to medical treatment and should be resorted to surgery only if drug therapy fails. Despite surgical intervention, tuberculosis perforation has a high complication and mortality rate. We present a case of 54-year-old male patient with a perforated jejunal stricture who had completed his treatment for pulmonary tuberculosis one month earlier. This case was unusual because of the age of patient at presentation (usually seen in young - 25 to 45 y), involvement of jejunum (commonly ileocaecal region), initial presentation with subacute obstruction followed by peritonitis (refused treatment at first instance) and patient having completed treatment for pulmonary tuberculosis recently.
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Affiliation(s)
- Naveen N
- Senior Resident, Department of Plastic Surgery, RajaRajeswari Medical College and Hospital , Bangalore, India
| | - Avijeet Mukherjee
- Associate Professor, Department of General Surgery, College of Medicine and JNM Hospital, West Bengal University of Health Sciences , Kolkata, India
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Joyati Tarafder A, Mahtab MA, Ranjan Das S, Karim R, Rahaman H, Rahman S. Abdominal Tuberculosis: A Diagnostic Dilemma. Euroasian J Hepatogastroenterol 2015; 5:57-59. [PMID: 29201690 PMCID: PMC5578524 DOI: 10.5005/jp-journals-10018-1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
According to the World Health Organization, more than 2 billion people are estimated to be infected with tuberculosis (TB) and approximately 95% of tuberculosis cases occur in developing countries. Extrapulmonary forms of tuberculosis constitute approximately one-sixth of all cases and the prevalence of extrapulmonary tuberculosis (TB) seems to be rising, particularly due to increasing prevalence of acquired immunodeficiency syndrome (AIDS). In patients with extrapulmonary TB, abdomen is involved in 12% of patients. Gastrointestinal involvement is found in 66 to 75% of abdominal cases, with the terminal ileum and the ileocecal region being the most common sites of involvement. Here, we report a case of abdominal TB.
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Affiliation(s)
| | - Mamun-Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sisir Ranjan Das
- Department of Neonatology, Dhaka Medical College, Dhaka, Bangladesh
| | - Rezaul Karim
- Upazila Health Complex, Dhamrai, Dhaka, Bangladesh
| | | | - Salimur Rahman
- Department of Hepatology, Mymensingh Medical College, Mymensingh, Bangladesh
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Papis D, Branchi V, Gomez L, Herrerias F, Vilardell F, Gonzalez M, Olsina JJ. Abdominal tuberculosis mimicking Crohn's disease's exacerbation: A clinical, diagnostic and surgical dilemma. A case report. Int J Surg Case Rep 2014; 6C:122-5. [PMID: 25528041 PMCID: PMC4337931 DOI: 10.1016/j.ijscr.2014.11.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/27/2014] [Accepted: 11/28/2014] [Indexed: 12/04/2022] Open
Abstract
Tuberculosis is a health public problem, which has increased over the last 20 years. The diagnosis of extrapulmonary tuberculosis can be challenging, and in particular clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage, anyway diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.
Introduction Tuberculosis in Europe is a health public problem, which has increased constantly over the last few decades. The most common clinical manifestation of tuberculosis is pulmonary. The diagnosis of extrapulmonary tuberculosis can be challenging and clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies. Presentation of case A young Chinese man, who had recently been diagnosed with Crohn’s disease, was admitted to the emergency room of our hospital with a one-month history of diffuse abdominal pain and weight loss. The patient initially presented with epigastric pain, which had been constantly increasing over the last 48 h. Other symptoms included diarrhea, nausea, and fever. The patient was then admitted with the diagnosis of Crohn’s disease exacerbation, and a treatment with corticosteroids, azathioprine, mesalazine, adalimumab, and antibiotic therapy was started. The symptoms were due to an initially misdiagnosed case of abdominal tuberculosis. Discussion Intestinal tuberculosis is mainly localized at the ileocecal level in 85% of patients. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage.
Conclusion The diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.
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Affiliation(s)
- Davide Papis
- Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Vittorio Branchi
- Department of Surgery, Bonn University Hospital, Sigmund-Freud-Strasse 25, Bonn 53127, Germany.
| | - Luis Gomez
- Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Fernando Herrerias
- Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Felip Vilardell
- Anatomical Pathology Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Marta Gonzalez
- Hepatobilyopanctratic Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Jorge J Olsina
- General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
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Goel V, Shivakumar K, Rajaram B, Sinha N, Garg I. Tuberculous celiac axis lymphadenopathy mimicking cystic pancreatic neoplasm - a diagnostic dilemma. Indian J Surg Oncol 2014; 5:278-81. [PMID: 25767339 DOI: 10.1007/s13193-014-0320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
Cystic pancreatic neoplasms are tumors with malignant potential treated surgically. Isolated tuberculosis of celiac lymph nodes is rare, treatment of this entity being non-surgical. Radiological appearances of cystic pancreatic neoplasm and tuberculous peripancreatic lymph nodal mass is similar and difficult to differentiate. Here we present a case of mass lesion in the region of pancreatic head mimicking cystic pancreatic neoplasm which was actually abdominal tuberculous lymphadenopathy proven by biopsy.
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Affiliation(s)
- Vipin Goel
- Dept of surgical oncology, St John's Medical College, Bangalore, India
| | - K Shivakumar
- Dept of surgical oncology, St John's Medical College, Bangalore, India
| | - B Rajaram
- Dept of surgical oncology, St John's Medical College, Bangalore, India
| | - Namitha Sinha
- Dept of Radiology, St John's Medical College, Bangalore, India
| | - Isha Garg
- Dept of Radiology, St John's Medical College, Bangalore, India
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Abstract
BACKGROUND Despite recent improvements in medical treatments, the incidence of abdominal tuberculosis (ATB) in the United Kingdom has increased over the past two decades. This case series examined the difficulties encountered in correctly diagnosing this infection. PATIENTS AND METHODS A retrospective study was undertaken, reviewing the records of 36 patients diagnosed with ATB from 2000 to 2012 at a district general hospital in outer East London. RESULTS The commonest presenting feature was abdominal pain in 67% of patients, and the most common sites of infection were the iliocaecal junction and peritoneum, seen in 36.1% and 33.3% respectively. Six patients were initially investigated for Crohn's disease and one for ileitis. The highest disease prevalence was seen in patients born in India and Pakistan, which was 27.8% and 19.4% of patients respectively. Colonoscopy was performed in nine patients, and three of these reported normal findings. The other six reported visible non-specific inflammatory changes. Three patients had abdominal X-rays reported and one patient had an abdominal ultrasound, all of which were normal. An abdominal computerised topography (CT) scan was performed in 26 patients and a chest CT was undertaken in 19 patients. Varying degrees of inflammatory changes were seen in all of the patients who had CT scans. Microbiological culture was positive for Mycobacterium tuberculosis or acid-fast bacilli in 71% of patients. CONCLUSIONS Abdominal tuberculosis can be very difficult to diagnose as symptoms are non-specific and can mimic other types of granulomatous inflammatory bowel diseases. Radiology appears largely unhelpful due to the non-specificity of any positive imaging findings, and there is a lack of diagnostic procedural and microbiological tests with high specificity and sensitivity. In view of the increasing incidence of tuberculosis in London, there should be a high index of suspicion for ATB in individuals from high-incidence countries who present with non-specific abdominal symptoms.
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Affiliation(s)
- Kerry A Burke
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Student Office, Garrod Building, Turner Street, Whitechapel, London E1 2AD, UK.
| | - Ashish Patel
- University of Southampton, Medical School, Builging 85, Life Sciences Building, Highfield Campus, Southampton SO17 1BJ, UK
| | | | | | - Steven J Snooks
- King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, UK
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Burke KA, Patel A, Jayaratnam A, Thiruppathy K, Snooks SJ. Diagnosing abdominal tuberculosis in the acute abdomen. Int J Surg 2014; 12:494-9. [PMID: 24560849 DOI: 10.1016/j.ijsu.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite recent improvements in medical treatments, the incidence of abdominal tuberculosis (ATB) in the United Kingdom has increased over the past two decades. This case series examined the difficulties encountered in correctly diagnosing this infection. PATIENTS AND METHODS A retrospective study was undertaken, reviewing the records of 36 patients diagnosed with ATB from 2000 to 2012 at a district general hospital in outer East London. RESULTS The commonest presenting feature was abdominal pain in 67% of patients, and the most common sites of infection were the iliocaecal junction and peritoneum, seen in 36.1% and 33.3% respectively. Six patients were initially investigated for Crohn's disease and one for ileitis. The highest disease prevalence was seen in patients born in India and Pakistan, which was 27.8% and 19.4% of patients respectively. Colonoscopy was performed in nine patients, and three of these reported normal findings. The other six reported visible non-specific inflammatory changes. Three patients had abdominal X-rays reported and one patient had an abdominal ultrasound, all of which were normal. An abdominal computerised topography (CT) scan was performed in 26 patients and a chest CT was undertaken in 19 patients. Varying degrees of inflammatory changes were seen in all of the patients who had CT scans. Microbiological culture was positive for Mycobacterium tuberculosis or acid-fast bacilli in 71% of patients. CONCLUSIONS Abdominal tuberculosis can be very difficult to diagnose as symptoms are non-specific and can mimic other types of granulomatous inflammatory bowel diseases. Radiology appears largely unhelpful due to the non-specificity of any positive imaging findings, and there is a lack of diagnostic procedural and microbiological tests with high specificity and sensitivity. In view of the increasing incidence of tuberculosis in London, there should be a high index of suspicion for ATB in individuals from high-incidence countries who present with non-specific abdominal symptoms.
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Affiliation(s)
- Kerry A Burke
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Student Office, Garrod Building, Turner Street, Whitechapel, London E1 2AD, UK.
| | - Ashish Patel
- University of Southampton, Medical School, Builging 85, Life Sciences Building, Highfield Campus, Southampton SO17 1BJ, UK
| | | | | | - Steven J Snooks
- King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, UK
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Dasgupta A, Singh N, Bhatia A. Abdominal tuberculosis: a histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. J Lab Physicians 2013; 1:56-61. [PMID: 21938251 PMCID: PMC3167969 DOI: 10.4103/0974-2727.59700] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Along with the increased incidence of pulmonary tuberculosis in parallel with the increase in population in various parts of the world, in recent years, the incidence of abdominal tuberculosis has also increased. The pathogenetic events in intestinal tuberculosis, which culminate in ulcer formation, perforation, and stricture, still have to be identified. AIM To correlate the gross and microscopic features in intestinal tuberculosis, in particular tuberculous perforation with changes in mesenteric vasculature. PATIENTS AND METHODS A one-year prospective study of excised/resected tissues from patients with abdominal tuberculosis requiring surgical intervention was conducted. Tissues from fifty-six patients were included in the study-of which 36 were resected intestinal segments and 20 were intestinal and lymph node biopsies. Hematoxylin and Eosin and Ziehl-Neelsen stains were used for histopathological examination. RESULTS Tuberculous enteritis was found to be present in 49 of the 56 patients (87.5%) (ileum being the site most commonly affected), while nodal involvement was seen in 39 (69.6%) patients. Perforations were present in 39 out of 49 (79.6%) intestinal tissues; most being solitary and ileum was the commonest site. Typical epithelioid cell granulomas were seen in the intestine and lymph nodes, with caseation being more prevalent in the latter. The mesenteric vasculature was frequently involved by granulomatous inflammation, with intravascular organizing thrombus being present in 30% of the resected specimens with perforation. Acid fast bacilli were demonstrated in the tissue sections of 37.5% of the patients. AFB positivity was higher in caseating granulomas. CONCLUSION Involvement of mesenteric vasculature by granulomatous inflammation was commonly associated with the ulcerative type with perforation, suggesting that ischemia caused by vascular thrombosis is responsible for tissue breakdown. This implies that vasculitis plays an important role in the natural history of abdominal tuberculosis.
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Affiliation(s)
- Alakananda Dasgupta
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Abstract
This is the first case report depicting masking of symptoms of intestinal tuberculosis by anabolic androgenic steroids (AAS) causing delay in diagnosis which lead to a major surgery. Negative tuberculosis skin test (TST) probably due to immunomodulating effects of AAS also contributed to the delay. Patient also had early dependence on AAS and rapid growth of scrotal sebaceous cysts, findings of which have not yet been reported.
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Affiliation(s)
- Suneet K Upadhyaya
- Department of Psychiatry, Veer Chandra Singh Garhwali Govt. Medical Science & Research Institute, Srinagar Garhwal, Uttarakhand, India
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Abstract
Background: Abdominal tuberculosis remains the great mimic despite years of experience and awareness. Reliable epidemiological data on abdominal tuberculosis are lacking in India. Objectives: To define the most suggestive clinical features of abdominal tuberculosis, to evaluate the usefulness of the normally available investigations, and the response of anti-tuberculous drugs. Study Design: Retrospective study. Materials and Methods: Out of 110 patients attending our hospital between July 2000 and June 2002, with clinical suspicion of abdominal tuberculosis, 46 patients had confirmed abdominal tuberculosis. Their clinico-radiological and cyto / histopathological profiles, side effects of anti-tuberculous drugs, and the outcome of the treatment were analyzed. Results: Weight loss, abdominal pain, and bowel disturbances were the most common symptoms. Anemia and under- nutrition, abdominal tenderness, ascites, and hepato / splenomegaly were the most common findings. Chest radiography showed active or healed tuberculous focus in 16. Ultrasonography revealed abdominal lymphadenopathy, ascites, and mass lesions in 26, 12, and four patients, respectively. Barium examination showed abnormality in eight patients out of 18, among whom it was performed. An ascitic fluid study done in 12 patients showed high adenosine deaminase in all, and positive acid fast bacilli in one. Laparoscopic peritoneal biopsy was done in18 patients, and 13 showed tuberculous granuloma. Treatment success was achieved in 38 patients with anti-tuberculous drugs. Most patients tolerated the anti-tuberculous drugs well. Conclusion: With good clinical examination and appropriate investigations definitive diagnosis of abdominal tuberculosis can be reached in a significant number of patients. Strongly suggestive clinical and laboratory data are also indications for anti-tuberculous therapy in an endemic country like India. Anti-tuberculous drugs are well tolerated and highly effective.
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Affiliation(s)
- Abhijit Mandal
- Department of Respiratory Medicine, Bankura Sammiloni Medical College, Kolkata, India
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Patel SM, Lahamge KK, Desai AD, Dave KS. Ovarian carcinoma or abdominal tuberculosis?-A diagnostic dilemma: study of fifteen cases. J Obstet Gynaecol India 2012; 62:176-8. [PMID: 23543459 DOI: 10.1007/s13224-012-0163-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 04/02/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the clinical, laboratory, and diagnostic features in women with abdominal tuberculosis that resembled advanced ovarian malignancy. METHODS A retrospective review of women with abdominal tuberculosis who were managed at GCRI Ahmedabad from 1996 to 2001 was undertaken. RESULTS Fifteen patients (3.06 %) with suspected ovarian cancer cases, finally diagnosed as abdominal tuberculosis over a 6-year period (1996-2001), are analyzed. During this period, 492 patients were operated for suspected ovarian malignancy. Pre-operatively, ultrasound-guided biopsies were inconclusive in 14 cases and hence, exploratory laparotomy was planned. They underwent laparotomy and biopsy for final diagnosis. Frozen sections-of peritoneal/omental biopsies in 11 cases and ovarian tumour in three cases-were indicative of tuberculosis in all the 14 cases. CONCLUSION The data of this study indicate that the majority of the cases with peritoneal tuberculosis can be diagnosed intra-operatively through the use of frozen section in conjunction with clinical features. Ascites and high levels of Ca125 do not necessarily indicate that the clinical picture is malignant in reproductive women. Laparoscopic tissue biopsy may be a fundamental tool in the management of such cases to avoid extended surgery.
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Abstract
18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT) imaging, an established procedure for evaluation of malignancy, shows an increased 18F-FDG uptake in inflammatory conditions. We present three patients with abdominal pain and weight loss. Conventional imaging studies indicated that abdominal neoplasm and 18F-FDG PET/CT for assessment of malignancy showed multiple lesions with intense 18F-FDG uptake in abdomen of the three cases. However, the three patients were finally diagnosed with multi-site abdominal tuberculosis (TB). Of them, two were diagnosed with TB by pathology, one was diagnosed with TB clinically. They recovered after anti-TB therapy. Few reports on accumulation of 18F-FDG in abdominal TB are available in the literature. A high index of suspicion is necessary to achieve an early diagnosis and a better outcome of the disease.
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Lee YJ, Jung SH, Hyun WJ, Kim SH, Lee HI, Yang HW, Kim A, Cha SW. A Case of Obstructive Jaundice Caused by Paradoxical Reaction during Antituberculous Chemotherapy for Abdominal Tuberculosis. Gut Liver 2009; 3:338-42. [PMID: 20431773 PMCID: PMC2852721 DOI: 10.5009/gnl.2009.3.4.338] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 06/23/2009] [Indexed: 12/02/2022] Open
Abstract
Abdominal tuberculosis is not a rare disease, but obstructive jaundice caused by tuberculosis (tuberculous lymphadenitis, tuberculous enlargement of the head of pancreas, and/or tuberculous stricture of the biliary tree) is rare. We recently experienced a case of obstructive jaundice as a result of paradoxical reaction of periportal tuberculous lymphadenopathy that was treated successfully with corticosteroid and biliary drainage. No similar cases have been reported previously.
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Affiliation(s)
- Yun Jung Lee
- Division of Gastroenterology, Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
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