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The Turkish Journal of Gastroenterology
2013, Volume 24, No 2, Pages 190-192
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A case of intestinal obstruction due to ileocecal tuberculosis
Ömer Faruk ÖZKAN 1 , Faruk ÖZKUL 1 , İsmail CAYMAZ 2 , Ali GÜNER 1 , Aydın KANT 3 , Erhan REİS 1
Department of 1 General Surgery, 2 Radiology and 3 Chest Medicine, Trabzon Numune Training and Research Hospital, Trabzon
Summary
Intestinal tuberculosis (ITB) is an extrapulmonary form of TB. Early correct diagnosis is important to prevent undue morbidity and mortality, but it can be quite difficult since ITB has no specific symptoms and mimics other disorders such as inflammatory bowel diseases and cancer. In this report, we present a case of intestinal obstruction due to ileocecal TB. The initial diagnosis suggested in our case was cancer of the cecum. A 38-year-old male patient applied to our emergency department with complaints of abdominal pain, nausea, and vomiting for two days and a history of similar episodes for the preceding two months. He had abdominal distention and tenderness. An upright abdominal radiograph demonstrated multiple air-fluid levels in the small bowel. Contrast-enhanced computed tomography demonstrated dilated small bowel loop and a mass located at the ileocecal valve (Figure 1A,B). During the laparotomy, dilated small bowel loops and fibrotic adhesions were seen between the peritoneum and colon. An obstructive mass was observed in the ileocecal area with multiple mesenteric lymphadenopathies. Bridectomy and right hemicolectomy were performed. Histopathological examination revealed an ulcerative form of TB with caseating granulomas and Langhans-type giant cells (Figure 2). Tuberculosis (TB) is a major public health problem that remains a leading cause of mortality in undeveloped countries. The incidence in developed nations is rising due to immigration and increasing prevalence of patients with human immunodeficiency virus (HIV) infection and immunosuppressive treatment (1). ITB has been classified as primary or secondary infection based on its association or not with pulmonary TB, and it is seen most commonly among young adults in their second and fourth decades of life. The incidence rate between genders is similar (2,3). Gastrointestinal TB is the sixth most common site to be affected. The ileocecal region is reported to be the area most commonly involved in ITB (3). The prolonged contact between the bacilli and mucosa may be the reason for the ileum and cecum being the most common sites of disease (2). Intestinal tuberculosis can have acute, chronic or acute on chronic presentation in the form of intestinal obstruction. Symptoms are non-specific and vary depending on the localization and presentation of the disease, and include abdominal pain, distention, vomiting, night sweats, weight loss, and diarrhea (3-5). The diagnosis is quite difficult since ITB closely mimics other disorders including Crohn's disease, amebiasis, carcinoma of the colon, and histoplasmosis (4,5). The first choice for diagnosis is colonoscopy and biopsy. The colonoscopic appearances in colonic TB are linear ulcers, nodules, pseudopolyps, and deformed cecum (6). Histopathologically, three types are described: ulcerative form (60%), hypertrophic form (10%) and ulcerohypertrophic form (30%). The ulcerohypertrophic form mostly mimics malignancies (7). In conclusion, ITB should be considered in the differential diagnosis of intestinal obstruction and can mimic other pathologies such as malignancies and inflammatory bowel disease.
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    7. Chong VH, Lim KS. Gastrointestinal tuberculosis. Singapore Med J 2009; 50(6): 638-45.
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