Intestinal Tuberculosis
Colonic Tuberculosis

Video Endoscopic Sequence 1 of 12.

A Case of Colonic Tuberculosis Mimicking Crohn's Disease.

Intestinal Tuberculosis in AIDS

This 26 year-old female, who underwent hysterectomy two years ago, with bilateral-salpingo-ooforectomy due to a cervical carcinoma. The patient presented with severe abdominal pain with right predominance since 10 months previously, and weight loss her blood test for Aids, was positive.

In addition the patient has been with several episodes of fever with anorexia. Aditional clinic finding of this patient, presented with Oropharynge-Esophagic Candidiasis.

Here, we report a case of isolated colonic tuberculosis where the initial diagnostic workup was suggestive of Crohn's disease. Computed tomography findings however, raised the possibility of colonic tuberculosis and the detection of acid-fast bacilli in biopsy specimens confirmed the diagnosis. this case highlights the need for awareness of intestinal tuberculosis in the differential diagnosis of chronic intestinal disease.

Download the video clips by clicking on the endoscopic images, if you wish to observe in full screen, wait to be downloaded complete then press Alt and Enter for Windows media, Real Player Ctrl and 3. Configure the windows media in repeat is optimal. All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode. 

 

coloni tuberculosis

Video Endoscopic Sequence 2 of 12.

The diagnosis of colonic tuberculosis requires a high index of suspicion.

Nodular ulcers with thickened mucosa covered with fibrin.
We could not get to the cecum, due to a lesion with severe narrowness in the ascending colon. n.

Clinical features of intestinal TB include abdominal pain, weight loss, anemia, and fever with night sweats. Patients may present with symptoms of obstruction, right iliac fossa pain, or a palpable mass in the right iliac fossa. Hemorrhage and perforation are recognized complications of intestinal TB, although free perforation is less frequent than in Crohn disease.

 

Coloni Tuberculosis

Video Endoscopic Sequence 3 of 12.

Ascendin Colon

The diagnosis of colonic tuberculosis requires a high index of suspicion. In cases where the information available does not reveal a definite differentiation between colonic tuberculosis and Crohn's disease.

Intestinal tuberculosis is a rare disease in western countries, affecting mainly immigrants and immunocompromised patients. Intestinal tuberculosis is a diagnostic challenge, especially when active pulmonary infection is absent. It may mimic many other abdominal diseases.

 

Coloni Tuberculosis

Video Endoscopic Sequence 4 of 12.

Colonic tuberculosis as a diagnostic challenge

Deep ulcerations exposing the deeper layers of the colonic wall and leaving islands of normal mucosa, with deformity of the lumen.

In this case of tuberculosis of the colon resemble a Crohn's disease, lesions are typically discontinuous. They can be adjacent to normal tissue, resulting in "skip areas" as in Crohn's disease.

In cases where the information available does not reveal a definite differentiation between colonic tuberculosis and Crohn’s disease, corticosteroids should be withheld. The administration of corticosteroids to a patient with colonic tuberculosis may have disastrous results, and a therapeutic trial of antituberculous drugs should be considered instead.

 

 

 


 

Colon tuberculosis

Video Endoscopic Sequence 5 of 12.

Image and video clip, after dye spraying with methylene blue the washing catheter for chromoendoscopy is appreciated.

In this clinical case, the inflammatory activity of the colon was only limited to the ascending colon. We did not fin any injury, neither in the rectum and descendent colon nor in the transverse.

 

 

 

 

Colon Tuberculosis

Video Endoscopic Sequence 6 of 12.

Seen after staining with methylene blue.

The ileocecal region is the most common site of tuberculosis in the gastrointestinal tract. The common imaging findings include thickening of the ileocecal valve and adjacent ileum and colon.
At CT, mesenteric lymphadenopathy with low attenuation suggestive of necrosis is typically found, although soft -tissue attenuation nodes occasionally occur, colonic tuberculosis can take several forms, including segmental ulceration, inflammatory strictures, and hypertrophic lesions that resemble polyps and masses.

 

Colon tuberculosis

Video Endoscopic Sequence 7 of 12.

Chromoendoscopy has been applied in a variety of clinical settings and throughout all gastrointestinal tract segments that are accessible to the endoscope.

The ileo-caecal area is reported to be the area most commonly involved in colonic tuberculosis.

 

Colon tuberculosis

Video Endoscopic Sequence 8 of 12.

A close up magnification of the lesion is observed, using a magnifying video endoscope after dye spraying. See video clip.

Intestinal tuberculosis is much more difficult to diagnose than pulmonary tuberculosis. One of the reasons is the very low diagnostic yield of endoscopic biopsy specimens..

The differentiation between intestinal tuberculosis and Crohn’s disease based on clinical features, radiology, endoscopy, and histology is often difficult.

 

Colon tuberculosis

Video Endoscopic Sequence 9 of 12.

A Tumorlike Appearance.

Colonoscopic image shows that colonoscope was unable to
pass stenotic segment.
Severe narrowness in the ascending colon. Involving the distal colon, with severe inflammation, edema, ulcers and stenosis. Because we could not pass the colonoscope behind the stricture, we could not examine the ileocecal region.

Colon tuberculosis

Video Endoscopic Sequence 10 of 12.

The colonoscope could not be introduced beyond the lesion.

Colonoscopy revealed a tumorous lesion in the ascending colon near the caecum.

The lymph nodes, peritoneum, and gastrointestinal tract are the most common sites of such involvement . In the gastrointestinal tract, common locations include the ileum, colon, and ileocecal valve, although any part of the gut may be involved.

 

Colon tuberculosis

Video Endoscopic Sequence 11 of 12.

Seen after staining with methylene blue.

Tuberculosis.--M tuberculosis is the most common cause ofserious HIV-related infection worldwide, although it is lesscommon in the United States than in other countries. About 43%of HIV-infected persons develop tuberculosis in developingcountries , whereas only 4% develop tuberculosis in the UnitedStates. Tuberculosis in HIV-infected patients tends to occurearlier than other AIDS-defining opportunistic infections, usuallywhen the patient's CD4 cell count is in the range of 150 350 cellsper microliter.

 

Colon tuberculosis

Video Endoscopic Sequence 12 of 12.

A close-up image.

For more endoscopic details download the video clips by clicking on the images.

The importance of considering tuberculosis in patients presenting with Crohn's disease. In this regard colonoscopy with tissue culture of targeted biopsy may be a valuable aid in establishing the diagnosis of tuberculous colitis.

 

Colon tuberculosis

Video Endoscopic Sequence 1 of 11.

This 54-year-old male fisherman, was seen as an emergency because of massive rectal bleeding, his hemoglobin was 6.3 GR./dl, serology for HIV was negative, Rectal examination revealed dark, red blood on the examining finger, two moths previously undergone a cerebral surgery due to an astrocitoma.

A full colonoscopy was carried out in order to determinate the exact etiology of this hemorrhage of the patient, in this image and the video clip shows some diverticulae and dark blood.

 

Colon tuberculosis

Video Endoscopic Sequence 2 of 11.

The colon was seen filled with dark blood.

The main symptom of lower GI bleeding is blood exiting the anus, either alone (bright red blood per rectum) or as red-stained stool (hematochezia). Stool that is tarry and dark (melena) typically points to upper GI bleeding. Otherwise, bleeding over time results in anemia, characterized by lower than normal blood hemoglobin and hematocrit with symptoms like weakness, fatigue, and fainting.

 

 

 

 

 

Colon tuberculosis

Video Endoscopic Sequence 3 of 11.

Large ulcer with an elevated margin

Intestinal tuberculosis (TB) is rarely seen in western countries, affecting mainly immigrants and immunocompromised patients. However, the incidence of abdominal TB has been steadily increasing for the past 20 years and a reported 2–3% of patients with abdominal TB have isolated colonic involvement. Intestinal TB is usually a diagnostic challenge, particularly in the absence of active pulmonary infection. It may mimic many other abdominal diseases, such as other infectious processes, tumors, periappendiceal abscess, and Crohn's disease (CD). Several cases of intestinal TB have so far been described including a few reports of intestinal TB mimicking CD. The differential diagnosis between TB and CD is important because if TB is suspected, empiric treatment with antituberculous drugs should be considered, especially if an immunosuppresive treatment for CD is to be initiated.

 

 

 

 

Colon tuberculosis

Video Endoscopic Sequence 4 of 11.

The apparent affinity of the tubercle bacillus for lymphoid tissue and areas of physiologic stasis facilitating prolonged contact between the bacilli and the mucosa may be the reasons for the ileum and cecum being the most common sites of disease. Other areas of the colon besides the ileocaecal area represent the next more common site of tuberculous involvement of the GI tract, usually manifested as segmental colitis involving the ascending and transverse colon.


 

Colon tuberculosis

Video Endoscopic Sequence 5 of 11.

The cecum area showing ulceration of the ileocecal valve

Colonic TB may present as an inflammatory stricture, hypertrophic lesions resembling polyps or tumors, segmental ulcers and colitis or rarely, diffuse tuberculous colitis. The diagnosis can be quite difficult since there are no specific clinical symptoms of large bowel TB and only a quarter of patients have chest radiographs showing evidence of active or healed pulmonary infection. The clinical, radiological and endoscopic picture is most likely to be confused with neoplasms or Crohn's disease, and infrequently with other considerations including amoeboma, Yersinia infection, GI histoplasmosis, and periappendiceal abscess.

 

 

 

 

Colon tuberculosis

Video Endoscopic Sequence 6 of 11.

The median duration of symptoms is usually less than one year. Pain predominantly in the lower abdomen is the commonest symptom of presentation. In one-third of patients lower gastrointestinal bleeding is present. Fever, anorexia, weight loss and altered bowel habit are the other manifestations. Obstruction, massive bleeding and rarely perforation are the complications reported.

 

Colon tuberculosis

Video Endoscopic Sequence 7 of 11.

Tuberculosis may affect any part of the gastrointestinal tract, but it most commonly involves the terminal ileum and ileocaecal region, as does Crohn’s disease.

 

Colon tuberculosis

Video Endoscopic Sequence 8 of 11.

Colonoscopy is a non-invasive procedure that provides much information about the mas and nature of involvement and facilitates biopsy collection. Colonoscopic findings of nodular, noduloulcerative or ulcerative lesions with erythematous surrounding mucosa and thickened edematous ileocecal valve are suggestive of Tuberculosis.

 

Colon tuberculosis

Video Endoscopic Sequence 9 of 11.

In this video multiple ulcers of the ascending colon and cecum are observed with the retroflexed maneuver that was performed from the cecum all the way to the rectum using a adult colonoscope.

This video is of great size is recommended to download with a fast connection of internet.

 

Colon tuberculosis

Video Endoscopic Sequence 10 of 11.

Inflammatory stricture, hypertrophic lesions resembling polyp or tumor, segmental transverse ulcers and segmental or diffuse colitis are the pathological presentations of colonic tuberculosis.

With the resurgence of tuberculosis as a result of HIV, it is important to keep this diagnosis foremost and manage it medically, if possible.

 

Colon tuberculosis

Video Endoscopic Sequence 11 of 11.

Colonic tuberculosis can present in several forms. The most common involvement is in the form of segmental ulcers and colitis, inflammatory strictures and hypertrophic lesions resembling polyps or masses.

The colonoscopic features of colonic tuberculosis include erythema, mucosal nodules, ulcers, strictures, and a deformed ileocaecal valve. These features are non-specific, however, and can also occur in Crohn’s disease. In contrast, distinguishing histological features of granulomas in intestinal tuberculosis and Crohn’s disease have been described. Caseation, if present, strongly suggests tuberculosis, but central acute necrosis of granulomas may also be seen occasionally in Crohn’s disease. Further, hyalinisation of granulomas is a typical feature of tuberculosis but is uncommon in Crohn’s disease. One must bear in mind, however, that sampling error on biopsy may lead to the failure of detecting granulomas in biopsy specimens from patients with either condition. In addition, granulomas in colonic tuberculosis may not always show caseation, despite repeated, multiple colonoscopic biopsies.

 

 

 

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