Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

Abstract

BACKGROUND Mycobacterium tuberculosis (TB) is the causative agent of TB, a chronic granulomatous illness. This disease is prevalent in low-income countries, posing a significant global health challenge. Gastrointestinal TB is one of the three forms. The disease can mimic other intra-abdominal conditions, leading to delayed diagnosis owing to the absence of specific symptoms. While gastric outlet obstruction (GOO) remains a frequent complication, its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy. Gastroduodenal TB can cause upper gastrointestinal hemorrhage, obstruction, and malignancy-like tumors. CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain, distension, nausea, vomiting, and weight loss, prompting a referral to a gastroenterologist clinic. Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation. However, treatment was interrupted, possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes. Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall. Resection revealed gastric wall effacement with TB. CONCLUSION Primary gastric TB is rare, frequently leading to GOO. Given its rarity, suspicions should be promptly raised when encountering relevant symptoms, often requiring surgical intervention for diagnosis and treatment.

Recognizing and addressing the challenges of gastrointestinal tuberculosis

“…These symptoms and findings can mimic many other intra-abdominal pathologies, leading to delays in diagnosis. As in the case of Ali et al [ 8 ], patients may also present with complaints caused by complications. Although the patient had complaints for a long time, he could not access effective treatment did not comply with empirically initiated antituberculosis treatment, and finally; when surgery was performed for gastric outlet obstruction, the definitive diagnosis was made with the pathology results[ 8 ].…”

“…As in the case of Ali et al [ 8 ], patients may also present with complaints caused by complications. Although the patient had complaints for a long time, he could not access effective treatment did not comply with empirically initiated antituberculosis treatment, and finally; when surgery was performed for gastric outlet obstruction, the definitive diagnosis was made with the pathology results[ 8 ]. Obstruction, perforation, fistula, abdominal collection-abscess, and gastrointestinal bleeding may also be observed due to complications[ 33 ].…”

“…Surgical intervention may be necessary in cases of severe complications such as gastric outlet obstruction, with procedures like gastrojejunostomy often performed to relieve obstruction and restore gastrointestinal function[ 45 ]. Similarly, in the case of Ali et al [ 8 ], antrectomy, roux-en-y reconstruction, and gastrojejunostomy were performed. In cases where the diagnosis has not been fully established, it is important to examine these pathological samples histopathologically with appropriate mycobacterial tests[ 8 ].…”

“…Research indicates that physicians entertained the diagnosis in fewer than 40% of patients upon their initial presentation[ 6 , 7 ]. The recent case report by Ali et al [ 8 ] shed light on an infrequent yet significant manifestation of this disease-primary GTB presenting as gastric outlet obstruction[ 8 ]. Delays in diagnosis, as in this case, lead to the development of complications, resulting in serious morbidity and mortality.…”

Primary extrapulmonary tuberculosis diagnosis warrants extra-precautious pulmonary tuberculosis exclusion workup

“…This letter is in response to the case report published by Ali et al [ 1 ] reporting a case of a young male with yearlong gastrointestinal symptoms, weight loss, and a history of incomplete antitubercular treatment undergoing operative interventions to relieve gastric outlet obstruction. Post-operatively, the patient was diagnosed with primary gastrointestinal tuberculosis based on histopathological examination of resected bowel segments.…”