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Small bowel tuberculosis causing massive obscure gastrointestinal bleeding in an immunocompromised patient.

Sharma V, Rana SS, Dhaka N, Saikia UN, Hemanth KK, Gupta R, Bhasin DK - Ann Gastroenterol (2015 Oct-Dec)

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Narendra Dhaka, Deepak K. Bhasin), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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A 50-year-old male presented with passage of maroon colored stools for one week... This was associated with postural symptoms and prior to his transfer to us he had received multiple packed red cell transfusions elsewhere... The patient underwent capsule endoscopy which revealed multiple areas of narrowing and ulcerations lesions in distal jejunum and proximal ileum (Fig. 1 A,B)... Chest X-ray was normal and tuberculin skin test was positive... The patient was started on quadruple anti-tubercular therapy and his symptoms improved... Small bowel tuberculosis is an unusual cause of massive gastrointestinal bleeding although it has occasionally been reported... Small bowel tuberculosis usually involves the ileocecal junction and involvement of small bowel without involvement of ileocecal junction as in our case is very rare... Small bowel tuberculosis has been diagnosed by capsule endoscopy in a patient with evidence of small bowel strictures Capsule findings reported in small bowel tuberculosis include strictures, ulcers, and lymphangiectasia... Small bowel tuberculosis must be considered as a cause of obscure gastrointestinal bleeding in patients from tropical countries.

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(A,B) Capsule endoscopy: Large ulcers with narrowing of the small bowel
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Figure 1: (A,B) Capsule endoscopy: Large ulcers with narrowing of the small bowel

Mentions: A 50-year-old male presented with passage of maroon colored stools for one week. This was associated with postural symptoms and prior to his transfer to us he had received multiple packed red cell transfusions elsewhere. The patient had undergone a renal transplant elsewhere 18 years ago and was presently receiving steroids and everolimus. The patient underwent esophagogastroduodenoscopy and colonoscopy which were normal. On colonoscopy, fresh and altered blood was observed in the colon and terminal ileum. In view of ongoing bleeding, a computed tomography angiography was done which was normal. The patient was started on intravenous octreotide and the bleeding subsided. The patient underwent capsule endoscopy which revealed multiple areas of narrowing and ulcerations lesions in distal jejunum and proximal ileum (Fig. 1 A,B). The patient excreted the capsule 28 h later. The patient underwent laparotomy with resection of the involved area. The resected small bowel revealed a large ulcer (Fig. 2A). The histopathology revealed evidence of tuberculosis with numerous epithelioid cell granulomas with Langhans type giant cells (Fig. 2B) and the stain for acid-fast bacillus was positive. Chest X-ray was normal and tuberculin skin test was positive. The patient was started on quadruple anti-tubercular therapy and his symptoms improved.


Small bowel tuberculosis causing massive obscure gastrointestinal bleeding in an immunocompromised patient.

Sharma V, Rana SS, Dhaka N, Saikia UN, Hemanth KK, Gupta R, Bhasin DK - Ann Gastroenterol (2015 Oct-Dec)

(A,B) Capsule endoscopy: Large ulcers with narrowing of the small bowel
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585399&req=5

Figure 1: (A,B) Capsule endoscopy: Large ulcers with narrowing of the small bowel
Mentions: A 50-year-old male presented with passage of maroon colored stools for one week. This was associated with postural symptoms and prior to his transfer to us he had received multiple packed red cell transfusions elsewhere. The patient had undergone a renal transplant elsewhere 18 years ago and was presently receiving steroids and everolimus. The patient underwent esophagogastroduodenoscopy and colonoscopy which were normal. On colonoscopy, fresh and altered blood was observed in the colon and terminal ileum. In view of ongoing bleeding, a computed tomography angiography was done which was normal. The patient was started on intravenous octreotide and the bleeding subsided. The patient underwent capsule endoscopy which revealed multiple areas of narrowing and ulcerations lesions in distal jejunum and proximal ileum (Fig. 1 A,B). The patient excreted the capsule 28 h later. The patient underwent laparotomy with resection of the involved area. The resected small bowel revealed a large ulcer (Fig. 2A). The histopathology revealed evidence of tuberculosis with numerous epithelioid cell granulomas with Langhans type giant cells (Fig. 2B) and the stain for acid-fast bacillus was positive. Chest X-ray was normal and tuberculin skin test was positive. The patient was started on quadruple anti-tubercular therapy and his symptoms improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Narendra Dhaka, Deepak K. Bhasin), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 50-year-old male presented with passage of maroon colored stools for one week... This was associated with postural symptoms and prior to his transfer to us he had received multiple packed red cell transfusions elsewhere... The patient underwent capsule endoscopy which revealed multiple areas of narrowing and ulcerations lesions in distal jejunum and proximal ileum (Fig. 1 A,B)... Chest X-ray was normal and tuberculin skin test was positive... The patient was started on quadruple anti-tubercular therapy and his symptoms improved... Small bowel tuberculosis is an unusual cause of massive gastrointestinal bleeding although it has occasionally been reported... Small bowel tuberculosis usually involves the ileocecal junction and involvement of small bowel without involvement of ileocecal junction as in our case is very rare... Small bowel tuberculosis has been diagnosed by capsule endoscopy in a patient with evidence of small bowel strictures Capsule findings reported in small bowel tuberculosis include strictures, ulcers, and lymphangiectasia... Small bowel tuberculosis must be considered as a cause of obscure gastrointestinal bleeding in patients from tropical countries.

No MeSH data available.


Related in: MedlinePlus