Complications of tuberculous enteritis occurring during antimicrobial therapy.

Abstract

graphic evidence of involvement of the gastrointestinal tract, while in advanced cases the incidence is 70 to 80%.14 In cases studied at necropsy, the incidence reported by different authors ranges from 65 to 90%.4 The commonest site of involvement is the cecum, as 87% of patients with tuberculous enteritis have lesions in this area. The next commonest site is the ileum. The remainder of the colon, the jejunum, the appendix, sigmoid and rectum, duodenum, and stomach are involved in a decreasing order of frequency.13 These figures were obtained prior to the advent of the antituberculosis drugs, and no comparable figures are available at the present time for comparison. However, in all probability, the incidence is decreasing with the increasing utilization of streptomycin, PAS, and isoniazid, as these drugs aid in attaining negativity of the sputum rapidly. Successful therapy of tuberculous enteritis with antimicrobial therapy has been reported.* Kallqvist reported that of 22 patients with secondary tuberculosis of the intestines treated by PAS, roentgenographic evidence of complete resolution was found in 10 cases, and there was regression in 7. There was only one patient who did not have subjective improvement.9 The complications of tuberculous enteritis are hemorrhage, obstruction, perforation with abscess, free perforation, and fistula formation. Even before antimicrobial drugs were used, none of these complications was common, and the complication of free perforation was quite rare.f Cullen, in a study of 734 cases of tuberculous enteritis seen at necropsy, found only 10 cases in which free perforation had occurred.* At the present time, one might anticipate that the complication rate is even lower. This impression appears to be substantiated by the paucity of recorded data, for a review of the literature for the past 14 years revealed only five articles in the English language which discussed clinical management of the complications of tuberculous enteritis.! None of the cases reported therein were cases of free