Gastric outlet obstruction secondary to peptic ulcer disease in a case of abdominal Koch’s

Abstract

Gastroduodenal tuberculosis (TB) presenting as gastric outlet obstruction is rare and often misdiagnosed, it is usually secondary to pulmonary tuberculosis and is often associated with HIV infection. Gastro-duodenal involvement is rarer disease (1%) in abdominal TB. We report a case of a 43-year-old male with no evidence of pulmonary tuberculosis and retroviral infection with complaints of abdominal pain since 4 months and features of gastric outlet obstruction, contrast enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP) were suggestive of pneumobilia, and on endoscopy bilioenteric fistula was confirmed also features of pan gastritis and duodenitis with concentric wall thickening noted at D1 and D2, although histological examination of biopsies showed no evidence of malignancy or tuberculosis. The diagnosis was established after surgery, when a specimen of an enlarged lymph node was sent for histopathological examination (HPE) and GeneXpert showed the presence of giant cells and caseating granuloma. The surgery performed was Roux-en-Y gastrojejunostomy. In this patient the rare gastroduodenal location of tuberculosis occurred as primary disease in the absence of other organ involvement. To the best of our knowledge this has been the first case reported as gastric outlet obstruction with bilioenteric fistula due to gastroduodenal tuberculosis.