Limits...
Ileal tuberculosis presenting as a case of massive rectal bleeding.

Kela M, Agrawal A, Sharma R, Agarwal R, Agarwal VB - Clin Exp Gastroenterol (2009)

Bottom Line: Fewer than 12 cases are reported in the literature.We report a case of ileal tuberculosis presenting at the emergency department with subacute intestinal obstruction and severe rectal bleeding.The case of the massive bleeding could be identified only after an exploratory laparotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, S.A.I.M.S., Medical College, Indore, Madhya Pradesh, India.

ABSTRACT
Massive rectal bleeding is an uncommon presentation of ileal tuberculosis. Fewer than 12 cases are reported in the literature. We report a case of ileal tuberculosis presenting at the emergency department with subacute intestinal obstruction and severe rectal bleeding. The case of the massive bleeding could be identified only after an exploratory laparotomy.

No MeSH data available.


Related in: MedlinePlus

Histopathology slide showing the presence of epitheloid granulomas and Langhans-type giant cells and evidence of endarteritis, which is suggestive of tuberculous etiology.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3108638&req=5

f2-ceg-2-129: Histopathology slide showing the presence of epitheloid granulomas and Langhans-type giant cells and evidence of endarteritis, which is suggestive of tuberculous etiology.

Mentions: A 30-year-old male patient presented to us with a complaint of being unable to evacuate his bowels and flatulence for the previous two days and with persistant bleeding from the rectum for one day. No other positive history was elicited. On examination, patient was pale. He had a pulse rate of 120 beats/minute and blood pressure was 90/60 mm Hg. Rectal examination showed the presence of fresh blood. Ryle’s tube showed the presence of clear bile. Patient was stabilized haemodynamically. Upper gastrointestinal endoscopy performed was normal. Emergency investigations showed Hb of 4 g% and hematocrit 29%. The white blood cell count was 1,800/μl and platelet count was 95,000/μl. Chest X-ray was found to be normal. Patient’s rectal bleeding continued, hence a colonoscopy was performed, which could not be completed since the whole colon was filled with blood and blood clots. Hence a decision to explore the patient in view of persistent rectal bleeding was undertaken after adequate blood transfusion. At laparotomy terminal ileum was full of blood and a nonpassable stricture was seen in the terminal ileum one and a half feet from the ileocaecal junction and mesenteric lymph nodes were also enlarged. The rest of the bowel was unremarkable. A resection anastomosis of the stricture was performed. After opening the lumen of ileum which was resected, longitudinally we found polypoidal mass of size 3.5 × 2.5 × 2 cm intraluminally adjoining the stricture having hemorrhagic surface area. Rest of mucosa shows multiple superficial ulcers of size 0.5 cm (Figure 1). Histopathology showed the presence of epitheloid granulomas and Langhans-type giant cells and evidence of endarteritis, suggestive of tuberculous etiology (Figure 2) Patient was started on four anti-tubercular drugs, and had an uneventful post-operative recovery.


Ileal tuberculosis presenting as a case of massive rectal bleeding.

Kela M, Agrawal A, Sharma R, Agarwal R, Agarwal VB - Clin Exp Gastroenterol (2009)

Histopathology slide showing the presence of epitheloid granulomas and Langhans-type giant cells and evidence of endarteritis, which is suggestive of tuberculous etiology.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108638&req=5

f2-ceg-2-129: Histopathology slide showing the presence of epitheloid granulomas and Langhans-type giant cells and evidence of endarteritis, which is suggestive of tuberculous etiology.
Mentions: A 30-year-old male patient presented to us with a complaint of being unable to evacuate his bowels and flatulence for the previous two days and with persistant bleeding from the rectum for one day. No other positive history was elicited. On examination, patient was pale. He had a pulse rate of 120 beats/minute and blood pressure was 90/60 mm Hg. Rectal examination showed the presence of fresh blood. Ryle’s tube showed the presence of clear bile. Patient was stabilized haemodynamically. Upper gastrointestinal endoscopy performed was normal. Emergency investigations showed Hb of 4 g% and hematocrit 29%. The white blood cell count was 1,800/μl and platelet count was 95,000/μl. Chest X-ray was found to be normal. Patient’s rectal bleeding continued, hence a colonoscopy was performed, which could not be completed since the whole colon was filled with blood and blood clots. Hence a decision to explore the patient in view of persistent rectal bleeding was undertaken after adequate blood transfusion. At laparotomy terminal ileum was full of blood and a nonpassable stricture was seen in the terminal ileum one and a half feet from the ileocaecal junction and mesenteric lymph nodes were also enlarged. The rest of the bowel was unremarkable. A resection anastomosis of the stricture was performed. After opening the lumen of ileum which was resected, longitudinally we found polypoidal mass of size 3.5 × 2.5 × 2 cm intraluminally adjoining the stricture having hemorrhagic surface area. Rest of mucosa shows multiple superficial ulcers of size 0.5 cm (Figure 1). Histopathology showed the presence of epitheloid granulomas and Langhans-type giant cells and evidence of endarteritis, suggestive of tuberculous etiology (Figure 2) Patient was started on four anti-tubercular drugs, and had an uneventful post-operative recovery.

Bottom Line: Fewer than 12 cases are reported in the literature.We report a case of ileal tuberculosis presenting at the emergency department with subacute intestinal obstruction and severe rectal bleeding.The case of the massive bleeding could be identified only after an exploratory laparotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, S.A.I.M.S., Medical College, Indore, Madhya Pradesh, India.

ABSTRACT
Massive rectal bleeding is an uncommon presentation of ileal tuberculosis. Fewer than 12 cases are reported in the literature. We report a case of ileal tuberculosis presenting at the emergency department with subacute intestinal obstruction and severe rectal bleeding. The case of the massive bleeding could be identified only after an exploratory laparotomy.

No MeSH data available.


Related in: MedlinePlus