Both Massive Upper and Lower Gastrointestinal Hemorrhage Secondary to Tuberculosis

Abstract

We report a case of gastrointestinal tuberculosis, presenting with both massive upper and lower gastrointestinal bleeding that required two emergency operations. Massive bleeding is rare in gastrointestinal tuberculosis because of associated obliterative endarteritis. Tuberculosis should be considered in the differential diagnosis of massive gastrointestinal bleeding in the appropriate clinical setting even in an immunocompetent patient.

Isolated gastric tuberculosis presenting as massive hematemesis: Report of a case

“…12 Endoscopy is a useful diagnostic modality and the usual picture is that of thickening of the stomach, nodular lesions, stenosis of the pyloric channel, or reduction in the distensibility of the stomach. 16 Antitubercular drug treatment has been reported to result in good resolution of lesions in patients with minimal obstruction; 2,7,9,10 however, surgery is indicated for patients with complications. Histopathological confirmation of gastric tuberculosis from endoscopic biopsies is difficult as acid-fast bacilli have rarely been demonstrated.…”

“…2,7,9 The endoscopic picture in our patient was quite similar to that of Dieulafoy's ulcer. 1,3,7,16,17 Appropriate surgery needs to be performed in combination with antitubercular drug therapy for patients presenting with massive bleeding caused by gastric tuberculosis. Full thickness biopsies at laparotomy may allow for a more accurate diagnosis.…”

Primary gastric fundus tuberculosis in immunocompetent patient: a case report and literature review

“…Endoscopic brush cytology and biopsy is only occasionally successful in diagnosis [22]. Submucosal location of the lesion has been cited as a reason for failure of endoscopic biopsies [16,23]. Most patients are subjected to surgical intervention, and the diagnosis of gastric tuberculosis is made after surgery.…”