Tuberculous Colonic Stricture: Changing Topography of Large Bowel Disease in the USA

Abstract

Background: Tuberculosis is still rampant in many developing and third world countries. With the chronic nature of infection and changing immigration patterns US has seen a rise in tuberculosis as well. Although small bowel is the most common gastrointestinal organ affected by Tuberculosis, rarely it can cause stricture in large intestine. We present a case with active pulmonary tuberculosis who presented with weight loss and melena. Imaging and endoscopic evaluation showed a colonic stricture related to tuberculosis. Case report: 68-year-old Hispanic male was referred to gastroenterology service for evaluation of melena. He also had a significant unintentional weight loss. Patient was diagnosed with active pulmonary Tuberculosis one month prior to referral and was undergoing Directly Observed Therapy (DOT). No family history of colorectal neoplasia or inflammatory bowel disease was noted. Physical examination showed a mildly distended and tympanic abdomen. Laboratory evaluation showed microcytic hypochromic anemia without leukocytosis and thrombocytopenia. Blood chemistry showed normal creatinine and no electrolyte abnormalities. CT abdomen was done and was significant for 5 cm circumferential wall thickening of ascending colon. On colonoscopy patient was noted to have irregular stricture at 90 cm and adult colonoscope could not be passed through it. Biopsy was significant for stricture related to granulomatous inflammation with negative AFB and fungal stains. Conclusion: Although physicians in the US are very familiar with colonic strictures related to colorectal neoplasia and inflammatory bowel disease, tuberculous colonic stricture should be kept in the differential diagnosis with the changing demographic patterns. Understanding tuberculous GI disorders is very important as their management differs greatly from other causes of colonic strictures. Treatment of the underlying tuberculosis forms the mainstay with surgical resection reserved for refractory cases.Figure 1