Endoscopic diagnosis of ileocecal tuberculosis

Abstract

Intestinal tuberculosis as a complication of pulmonary mycobacterial infection has become extremely rare in Europe. The diagnosis on clinical and radiological grounds used to be tentative only and had to be confirmed by surgery and positive tissue cultures. The purpose of this report on a patient with symptomatic ileocecal tuberculosis is to emphasize the role of colonoscopy for diagnosis and the beneficial effect of chemotherapy alone. CASE REPORT A 38-year-old man of Turkish descent was referred to hospital in May 1977 because of a suspected colonic tumor. For the previous 2 years he had experienced a dull abdominal pain in the right lower quadrant, a tendency to constipation, and a continuous weight loss totalling 5 kg. Fever, chills, cough, expectoration, and bloody or tarry stools were absent. On examination he was in good physical condition. A tender, nonfixed tumor could be felt in the right iliac fossa. There was a leucocytosis of 1O,OOO,a repeatedly positive test for occult blood in feces, and a negative PPD test. All the other laboratory tests including hemoglobin were normal. Radiography showed a symmetrical, miliary appearance of the lungs and a shrinkage of the cecum with a destroyed ileocecal valve. The ileum seemed to have a partly granular and ulcerative appearance in the most distal 10 cm. (Figure 1). Colonoscopy revealed a cecum narrowed by thick, pseudopolypoid or ulcerated mucosal folds to a width of only about 15 mm. The ileocecal valve was not discernible and the