Tuberculosis of the gastrointestinal tract and associated viscera

Abstract

Tuberculosis involvement of the gastrointestinal tract, peritoneum, and associated viscera is an uncommon but well described entity. While peritoneal tuberculosis and tuberculous enteritis are more common, involvement of the esophagus, stomach, colon, rectum, anus, liver, bile ducts, gallbladder, and pancreas can occur. Diagnosis is challenging as cases often mimic neoplasm or inflammatory bowel disease. In this review we outline the pathogenesis, clinical presentation, diagnostic testing, and treatment strategies pertaining to such cases.

Intestinal perforation due to intestinal and colonic tuberculosis in a patient with HIV, a nearly lethal complication due to lack of adequate treatment and control in a limited resource country, a case report

“…Extrapulmonary infections occur in 9–40% of HIV patients, and are usually secondary to reactivation of a latent infection [5]. Due to its low prevalence and non-specific symptoms, extrapulmonary tuberculosis is difficult to diagnose and control [6,7]. Abdominal TB is the sixth most common form of TB and the commonest type of extrapulmonary tuberculosis in HIV patients [8].…”

“…It can affect any organ from the oral cavity to the rectum, and usually develops from the ingestion of contaminated respiratory secretions, hematogenous spread, or contiguous spread from infected organs or lymph nodes. After an initial entry, the mycobacteria infiltrate the intestinal epithelium into the submucosa producing inflammation, ulceration, bleeding, and ultimately perforation [6,7]. The ileocecal region is usually more affected due to more mucosal contact, the effects of digestion and the higher concentrations of lymphoid tissue [5,6].…”

“…After an initial entry, the mycobacteria infiltrate the intestinal epithelium into the submucosa producing inflammation, ulceration, bleeding, and ultimately perforation [6,7]. The ileocecal region is usually more affected due to more mucosal contact, the effects of digestion and the higher concentrations of lymphoid tissue [5,6]. Symptoms are generally non-specific and can mimic many abdominal pathologies; our patient presented some of the most common symptoms including fever, abdominal pain, night sweats, fatigue, weight loss, constipation, diarrhea, and bleeding [6,8].…”

“…Complications are rare and depend on the host immunity and the progression of the disease, and include perforation, bleeding, fistula formation, and obstruction [6,10]. Regretfully, 20–40% of patients will require surgical management [11,12].…”

Peritonitis tuberculosa en un niño

“…El espectro clínico no exhibe características específicas, dificultando el diagnóstico. Los síntomas y signos son principalmente constitucionales, siendo los más comunes ascitis (73%), dolor abdominal (65%), pérdida de peso (61%), fiebre (59%), diarrea (21%) y constipación (11%) 21 . Esporádicamente se presenta como una obstrucción intestinal 22 , abdomen agudo 23 o TBC grave diseminada (Sepsis tuberculosa gravissima) 24 .…”