Gastrointestinal Tuberculosis

Aka: Gastrointestinal Tuberculosis, Tuberculous Enteritis

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II. Pathophysiology

  1. Involves any part of Gastrointestinal Tract
  2. Ileocecal most commonly affected
  3. Risk of contracting gastrointestinal Tb
    1. Parallels severity of pulmonary disease
  4. Transmission
    1. Swallowing infected Sputum or contaminated food
    2. Hematogenous spread
    3. Contiguous spread from involved tissue

III. Symptoms

  1. Fever
  2. Weight loss
  3. Abdominal Pain
  4. Diarrhea

IV. Signs

  1. Blood in stool
  2. Palpable right lower quadrant mass

V. Differential Diagnosis

  1. Crohn's Disease
    1. Critical to differentiate from Tuberculosis
    2. Crohn's Treatment disseminates Tuberculosis
  2. Infection
    1. Yersinia
    2. Actinomyces
    3. Amebiasis
  3. Colon Cancer

VI. Diagnosis

  1. Endoscopy
    1. Mucosal injury
      1. Ulcerations
      2. Hypertrophic lesions
      3. Dense bandlike fibrosis
    2. Mucosal biopsy shows Acid Fast Bacilli (low yield)
    3. Culture of biopsy specimens
  2. CT Abdomen
  3. Barium Enema
    1. Shortened and retracted cecum

VII. Management

  1. See Extrapulmonary Tuberculosis
  2. Treat for six months

VIII. Complications

  1. Intestinal Obstruction
  2. Bowel perforation
  3. Enteric fistulas

IX. References

  1. Marshall (1993) Am J Gastroenterol 88:989-99 [PubMed]

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