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Intestinal tuberculosis previously mistreated as Crohn's disease and complicated with perforation: a case report and literature review.

Wu YF, Ho CM, Yuan CT, Chen CN - Springerplus (2015)

Bottom Line: Ileostomy takedown was performed, and the continuity of the gastrointestinal tract was restored 6 months after the first surgery.The patient recovered well thereafter.Timely surgical intervention can help establish the finial diagnosis of tuberculosis, rescue the patient from abdominal emergency, and provide a chance for cure.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT

Introduction: Tuberculosis is known as a notorious mimicker and distinguishing between intestinal tuberculosis and Crohn's disease is a huge diagnostic challenge.

Case description: Here, we report a case of hollow organ perforation due to intestinal tuberculosis that was previously mistreated as Crohn's disease. Staged operation with emergency resection of the diseased small bowel and temporary ileostomy was performed for the perforation, followed by 6-month standard treatment for miliary tuberculosis, which was diagnosed on the basis of the presence of acid-fast bacilli in the diseased bowel and positive culture of Mycobacterium tuberculosis from sputum, ascites, and stool samples. Ileostomy takedown was performed, and the continuity of the gastrointestinal tract was restored 6 months after the first surgery. The patient recovered well thereafter.

Conclusion: Timely surgical intervention can help establish the finial diagnosis of tuberculosis, rescue the patient from abdominal emergency, and provide a chance for cure.

No MeSH data available.


Related in: MedlinePlus

Histopathological examination of the surgical specimen. a The presence of acid-fast bacilli in the bowel (acid-fast stain); b granulomatous inflammation with caseating necrosis (H&E stain).
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Fig2: Histopathological examination of the surgical specimen. a The presence of acid-fast bacilli in the bowel (acid-fast stain); b granulomatous inflammation with caseating necrosis (H&E stain).

Mentions: A 42-year-old man experienced recurrent abdominal pain and weight loss (15 kg) in 2 years. The diagnosis of CD was made on the basis of abdominal computed tomography (ACT), barium radiographic study of small bowel, and colonoscopic findings. ACT showed skip lesions throughout the small bowel, and suspected healed enteroenteric fistula with multifocal mesenteric adhesion (Figure 1a). Barium radiographic study revealed segmental narrowing of ileum which favored post-inflammatory focal stricture (Figure 1b). Colonoscopic examination showed the presence of polypoid lesions in the terminal ileum (Figure 1c), of which two pieces were biopsied. The pathologic report was chronic inflammatory change without the presence of microorganism. Under the impression of CD, prednisolone and azathioprine were then prescribed but yielded a poor response. He presented to our emergency room with diffuse abdominal pain and intermittent fever 4 months after the initiation of treatment for CD. ACT revealed pneumoperitoneum and hollow organ perforation; the perforated site at the terminal ileum was confirmed by emergent laparotomy. Segmental small bowel resection with end ileostomy was performed for the small bowel perforation. The pathologic report showed granulomatous inflammation with the presence of acid-fast bacilli at the perforated site (Figure 2). Miliary TB was diagnosed with additional positive findings of polymerase chain reaction (PCR) and positive culture for Mycobacterium tuberculosis in sputum, stool, and ascites. Tracing back the initial presentation and medical history, no clue of tuberculosis was yielded in early plain films and in clinical presentation. Standard anti-TB treatment was initiated and the patient’s body weight increased, with drastic improvement in abdominal symptoms. Follow-up barium radiographic examination of the intestine (Figure 1d, left) showed no definite residual lesion after completion of his 6-month-course of anti-TB treatment. His body weight returned to his baseline weight of 65 kg, 2 months after ileostomy closure, and there were no abdominal complaints thereafter.Figure 1


Intestinal tuberculosis previously mistreated as Crohn's disease and complicated with perforation: a case report and literature review.

Wu YF, Ho CM, Yuan CT, Chen CN - Springerplus (2015)

Histopathological examination of the surgical specimen. a The presence of acid-fast bacilli in the bowel (acid-fast stain); b granulomatous inflammation with caseating necrosis (H&E stain).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493258&req=5

Fig2: Histopathological examination of the surgical specimen. a The presence of acid-fast bacilli in the bowel (acid-fast stain); b granulomatous inflammation with caseating necrosis (H&E stain).
Mentions: A 42-year-old man experienced recurrent abdominal pain and weight loss (15 kg) in 2 years. The diagnosis of CD was made on the basis of abdominal computed tomography (ACT), barium radiographic study of small bowel, and colonoscopic findings. ACT showed skip lesions throughout the small bowel, and suspected healed enteroenteric fistula with multifocal mesenteric adhesion (Figure 1a). Barium radiographic study revealed segmental narrowing of ileum which favored post-inflammatory focal stricture (Figure 1b). Colonoscopic examination showed the presence of polypoid lesions in the terminal ileum (Figure 1c), of which two pieces were biopsied. The pathologic report was chronic inflammatory change without the presence of microorganism. Under the impression of CD, prednisolone and azathioprine were then prescribed but yielded a poor response. He presented to our emergency room with diffuse abdominal pain and intermittent fever 4 months after the initiation of treatment for CD. ACT revealed pneumoperitoneum and hollow organ perforation; the perforated site at the terminal ileum was confirmed by emergent laparotomy. Segmental small bowel resection with end ileostomy was performed for the small bowel perforation. The pathologic report showed granulomatous inflammation with the presence of acid-fast bacilli at the perforated site (Figure 2). Miliary TB was diagnosed with additional positive findings of polymerase chain reaction (PCR) and positive culture for Mycobacterium tuberculosis in sputum, stool, and ascites. Tracing back the initial presentation and medical history, no clue of tuberculosis was yielded in early plain films and in clinical presentation. Standard anti-TB treatment was initiated and the patient’s body weight increased, with drastic improvement in abdominal symptoms. Follow-up barium radiographic examination of the intestine (Figure 1d, left) showed no definite residual lesion after completion of his 6-month-course of anti-TB treatment. His body weight returned to his baseline weight of 65 kg, 2 months after ileostomy closure, and there were no abdominal complaints thereafter.Figure 1

Bottom Line: Ileostomy takedown was performed, and the continuity of the gastrointestinal tract was restored 6 months after the first surgery.The patient recovered well thereafter.Timely surgical intervention can help establish the finial diagnosis of tuberculosis, rescue the patient from abdominal emergency, and provide a chance for cure.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT

Introduction: Tuberculosis is known as a notorious mimicker and distinguishing between intestinal tuberculosis and Crohn's disease is a huge diagnostic challenge.

Case description: Here, we report a case of hollow organ perforation due to intestinal tuberculosis that was previously mistreated as Crohn's disease. Staged operation with emergency resection of the diseased small bowel and temporary ileostomy was performed for the perforation, followed by 6-month standard treatment for miliary tuberculosis, which was diagnosed on the basis of the presence of acid-fast bacilli in the diseased bowel and positive culture of Mycobacterium tuberculosis from sputum, ascites, and stool samples. Ileostomy takedown was performed, and the continuity of the gastrointestinal tract was restored 6 months after the first surgery. The patient recovered well thereafter.

Conclusion: Timely surgical intervention can help establish the finial diagnosis of tuberculosis, rescue the patient from abdominal emergency, and provide a chance for cure.

No MeSH data available.


Related in: MedlinePlus