Colonic Tuberculosis Research Articles

S3048 Colonic Tuberculosis: A Case Report and Literature Review of the Endoscopic, Radiographic, and Biopsy Findings

S3048 Colonic Tuberculosis: A Case Report and Literature Review of the Endoscopic, Radiographic, and Biopsy Findings

Colonic Tuberculosis Mimicking Colonic Cancer: A Multidisciplinary Diagnosis and Case Report

Gastrointestinal tuberculosis accounts for 1% to 3 % of all TB cases worldwide. Colonic tuberculosis is rare and can be mistaken for malignancy. It commonly presents as chronic abdominal pain along with night sweats, diarrhea, and fatigue and can resemble variety of other diseases making the diagnosis difficult. It presents with vague clinical and radiological picture making the diagnosis challenging for the clinicians. Its diagnosis is usually made by combining clinical features, radiological, tissue AFP staining and histopathologal examinations. The typical histopathologic findings include confluent large granulomas and langhans giant cells with caseating necrosis. Gastrointestinal tuberculosis responds well to standard antituberculous drugs and surgery is done for patients that have complications like strictures or obstruction which does not respond to medical therapy. This case illustrates a 40 year old man who presented with crampy lower abdominal pain and diagnosed as a colonic cancer both on imaging and clinically which later found to have colonic tuberculosis on a colectomy histopathologic sample. He was treated with anti-TB and respond well to his treatment. This case will give an insight for treating physicians to have a high index of suspicion for colonic TB in a patient who presented with lower abdominal pain and having colonic mass.

An Incidental Finding of Primary Colonic Tuberculosis Disguising Itself as Colon Cancer

Abstract Intestinal tuberculosis (TB) is common among the extrapulmonary spectrum of TB seen in developing countries, with the ileocecal region being the most common site involved. Isolated colonic TB is rare among intestinal TB. The usual presentation of intestinal TB is transverse ulceration, which should be differentiated from other causes of intestinal ulcers. The diagnosis of isolated colonic TB is challenging due to a lack of typical clinical presentations and nonspecific colonoscopy findings. There are myriad histomorphological features seen in the intestinal tuberculosis, including epithelioid cell granulomas with or without necrosis and extensive fibrosis with stricture formation and sometimes only show dense mixed inflammatory cells comprising polymorphs and histiocytes. It can also be presented as spindle cell pseudotumors. The acid-fast bacilli in biopsy specimens are not frequently encountered. Hence, the diagnosis of intestinal TB is missed most of the time in the early stages, and the patient lands up in an emergency. Here, we would like to add another case of colonic TB to the literature, wherein a 60-year-old female who was asymptomatic for 1 month suddenly presented with acute symptoms of intestinal obstruction and was misdiagnosed clinically as well as radiologically as colonic carcinoma. The diagnosis of tubercular colitis was later confirmed on histopathological examination of the hemicolectomy specimen.

Colonic Tuberculosis Mimicking Ascending Colon Neoplasm: A Case Report

Tuberculosis is still a worldwide public health concern especially in developing countries. Extrapulmonary tuberculosis including abdominal tuberculosis is known as the great mimicker and usually delayed due to its nonspecific clinical presentation. A-30 years old male patient presented to our hospital with 5-months history of persistent lower right-sided abdominal pain, anorexia, and weight loss. Computed tomography scan of the abdomen suggested malignant mass of ascending colon. Chest x-ray showed suprahilar right lung fibro-infiltrates suggested lung tuberculosis. Colonoscopy was performed which revealed tumor of the hepatica flexure Biopsy was taken from colonoscopy showed non-specific colitis results. Surgery was performed due to suspicious of ascending colon malignancy. Histopathological evaluation of colon biopsy revealed features of caseating granulomas and Langerhans giant cells that consistent with tuberculosis. A diagnosis of colonic tuberculosis was concluded and the patient is treated with anti-tuberculosis drug regimens.

Pseudo-Tumoral Colonic Tuberculosis: About a Case Report and Review of the Literature

Pseudo-tumoral colonic tuberculosis is very rare disease with various clinical manifestations and difficult diagnosis assessment. Our observation concerns the case of a 34 years old female patient with no pathological history in whom a pseudo-tumoral colonic tuberculosis was suspected on CT scan and confirmed on anatomical examination of the operative specimen.

Pattern of Colorectal Diseases in Yemen

Background: Colonoscopy is a crucial procedure for the diagnosis and management of a broad spectrum of colorectal diseases (CRDs) worldwide. The study aims to evaluate the prevalence of CRDs in patients who underwent colonoscopy, as well as the pattern of CRDs in those with abnormal colonoscopic findings, in urban, suburban, and rural communities in Sana'a (Yemen) governance. Methods and Materials: This is a retrospective study of 500 patients who underwent colonoscopy over six years, between April 2008 and April 2014, at the Hepatobiliary and Gastroenterology Specialized Research Center in Sana'a, Yemen. The overall incidence of CRDs was determined in the study cohort, followed by a subgroup analysis to identify the pattern of CRDs in patients with clinical symptoms. Results: 336 (67.2%) were found to have normal colonoscopies. Another 164 patients who presented with symptoms (31.8 %) were found to have abnormal colonoscopic findings. Eight diseases were identified: ulcerative colitis (4.2%), Crohn’s disease (0.8%), microscopic colitis (8.4%), schistosomiasis (0.8%), colorectal polyps (12.2%), colonic tuberculosis (TB, 0.2%), diverticulosis (2.2%), and colorectal cancer (2.2%). In patients with abnormal colonoscopy, the most common presentations were bleeding per rectum (44 patients, 26.8%), abdominal pain (31 patients, 19.8%), diarrhea (30 patients, 18.3%), and constipation (21 patients, 12.8%). There were statistically significant differences in patients' ages between the eight groups (p<0.001). There were no significant difference between male and female patients regarding presentations or indications for colonoscopy (p=0.760), or histopathologic findings (p=0.402). Conclusion: The prevalence and pattern of CRDs in Yemen are different from the Western population. Understanding these differences should be considered when evaluating patients with CRDs. There are no differences between patients' genders regarding presentations and histopathologic diagnosis.

Colonic tuberculosis masquerading as ascending colon carcinoma in a patient of FIGO Stage IIB cervical carcinoma following chemo-radiotherapy: A case report

Introduction and importanceColonic tuberculosis may masquerade colonic carcinoma. Also, intestinal tuberculosis may mimic colonic carcinoma, Crohn's disease, ulcerative colitis, etc.Case presentationA 40 years female was diagnosed with cervical carcinoma FIGO Stage IIB underwent chemo-radiotherapy. She was symptom-free for a few months and then she developed right-sided abdominal pain and abdominal fullness for 4 months. She underwent a colonoscopy that showed ulcerative growth and friable tissue in hepatic flexure of colon and histopathology and immunohistochemistry findings suggested non-Hodgkin's lymphoma or poorly differentiated carcinoma. Then right standard hemicolectomy was performed and histopathology showed tuberculosis. The patient received medications for tuberculosis and the patient improved.Clinical findings and investigationsPreoperatively suspected colonic carcinoma in developing countries (where the prevalence of tuberculosis is high) may sometimes come out as colonic tuberculosis in histopathology. The biopsy sample taken from colonoscopy was examined by histopathology, which showed nonspecific results, and the case was mistakenly thought of as colonic carcinoma preoperatively.Interventions and outcomesThe case underwent right standard hemicolectomy and to the surprise, the excised specimen came out as tuberculosis. The patient received anti-tubercular drugs and the patient is symptomatically better.Relevance and impactColonic tuberculosis can mimic colonic carcinoma. Histopathology will confirm colonic tuberculosis and response to anti-tuberculosis drugs will verify the diagnosis. Though a patient undergoing chemotherapy may develop lymphoma, colonoscopic biopsy may not be conclusive. In any symptomatic patient with colonic stricture, surgery is the treatment of choice.

Deep Vein Thrombosis in a Patient of Extrapulmonary Tuberculosis

AbstractAmong the various complications reported to be caused by tuberculosis (TB), thrombogenic potential is a rare entity. Here, we report a case of colonic tuberculosis in a 30-year-old male who developed left upper limb deep vein thrombosis (DVT). Ruling out other possible causes of DVT and improvement of the affected limb with antitubercular drugs led to conclusion that DVT was most probably due to TB.

A Retrospective Cohort Study of Coexistence of Carcinoma and Tuberculosis of Colon: 12-Year Experience.

Coexistence of carcinoma colon and tuberculosis is rare. The aim of this study is to present our 12-year experience on colonic carcinoma with coexisting colonic TB. Histopathology and imaging records of 189 patients of colonic carcinoma patients who underwent treatment in surgical unit 6 in our institute between January 2006 and December 2017 were reviewed. In 7 patients, histopathology and/or imaging studies were suggestive of coexistence of colonic carcinoma and tuberculosis. Fifteen cases of colonic tuberculosis were also reviewed. Descriptive statistics were used to summarize the data. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The duration of symptoms spanned between 2 and 7weeks. Anorexia and weight loss were the predominant symptoms. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The morbidity was low and there was no surgery associated mortality. Clinical awareness and advancement in diagnostic studies and improvement in management strategies may guide and lead to early diagnosis, optimum therapeutic guidelines and thus improved outcome.

S1819 A Case of Abdominal Tuberculosis: A Reminder of the Great Mimicker

INTRODUCTION: Tuberculosis (TB) is considered the great mimicker, able to infiltrate multiple organ systems in unique but non-specific ways, requiring a high clinical suspicion. From a GI perspective, TB can mimic IBD, colorectal cancer, or other GI malignancies. It is among the top 10 causes of death worldwide and it is important to recognize the multiple manifestations of this treatable disease. CASE DESCRIPTION/METHODS: A 44 y/o male with a history of congenital blindness presented to the hospital with one month of dyspnea, low grade fevers, productive cough, and 55lb unintentional weight loss. He denied travel, sick contacts, abdominal pain, change in bowel habits. He denied tobacco history, alcohol history, or family history. Vitals on presentation were remarkable for HR 127, T 100.2F. Exam was remarkable for thin male, decreased breath sounds of left lower lung, benign abdominal exam. Labs were notable for ALP 282 U/L, albumin 2.2 g/dL, WBC 11.14 K/uL, Hg 10.8 g/dL, MCV 86.1 fL, PLT 524 K/uL. Chest X-ray demonstrated a large left pleural effusion. CT showed abnormal soft tissue along the ascending colon with fat stranding, thought likely malignant by radiology, and a left upper lobe mass-like opacity with mediastinal lymphadenopathy. Leading diagnosis was metastatic colorectal cancer. Thoracentesis showed exudative effusion; cytology, culture and AFB were negative x2. Colonoscopy showed a frond-like, villous, ulcerated, partially obstructing, large mass in the ascending colon; multiple biopsies revealed no malignant cells and were non-diagnostic. Right hemicolectomy revealed an inflammatory ileocecal mass with confluent caseating granulomas, with rod-shaped beaded organisms consistent with mycobacterium tuberculosis, also seen on omental and peritoneal biopsies. He was initiated on TB therapy. DISCUSSION: Abdominal TB comprises about 10% of extra-pulmonary TB and is often confused with IBD and colon cancer. CT is the imaging modality of choice. Confirmation is histopathological biopsy, with colonoscopy providing diagnostic biopsies ∼ 80% of the time (Shah). Remarkably, abdominal TB is a medical disease that can be treated with oral medications. Surgical intervention is reserved for surgical emergencies, such as obstruction, perforation or fistulation. Shah S, Thomas V, et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut. 1992;33:347–351.Figure 1.: Partially obstructing ascending colon mass.

Synchronous colonic malignancy and tuberculosis: a rare histologic surprise

Coexistence of colorectal cancer and tuberculosis of same site is described in few of case reports. Tuberculosis (TB) is known to involve any part of the body. Intestinal TB accounts for the majority of extra pulmonary TB, ileocecal region being the most common site. TB has been known to be associated with various types of malignancy. The most common association is malignancy and pulmonary TB. However, association of extra pulmonary TB and malignancy at the same site is relatively uncommon. This case report describes synchronous colonic malignancy and tuberculosis on histopathological evaluation of the resected specimen in a 42-year female patient.

A175 RECURRENT GASTROINTESTINAL BLEED – A LATE MANIFESTATION OF COLONIC TUBERCULOSIS TREATED CONSERVATIVELY

Abstract Background The incidence of active tuberculosis (TB) in Canada is 4.8 per 100000 persons. Globally, gastrointestinal (GI) TB is rare and accounts for 5% of all extra-pulmonary cases. Clinical manifestations of intestinal TB include weight loss (75%), abdominal pain (54%), and changes in bowel habits (50%). GI bleeding has been observed in 5–15% of confirmed cases of colorectal TB. The cecum is the most common site of involvement, with the most common gross finding on colonoscopy being ulcerations (88%), and the least common being polypoid lesions (10%). Intestinal TB is treated the same as pulmonary TB, with endoscopic healing observed in the majority of cases following 9 months of anti-TB therapy. Surgery is entertained in cases of non-resolving obstruction, perforation, or fistula formation. Aims Management of stable, recurrent, large volume GI bleeding in TB colitis is not well established. We report such a case that resolved solely by anti-TB regimen. Methods Case report Results A 56 year old man with chronic kidney disease presented with cachexia and 40 pound weight loss over 6 months after return from India. He underwent computerized tomography scan of his chest, abdomen and pelvis. Multiple, large, cavitary lesions in the right upper lung lobe were seen, and confirmed to be TB by bronchoalveolar lavage. Abdominal imaging identified moderate circumferential wall thickening at the cecum concerning for intestinal TB. These findings were also retrospectively noted on a review of an abdominal MRI 4 months prior. His course was complicated by episodes of large, alternating bright red blood per rectum and melena stools starting 5 days after initiation of anti-TB therapy. Colonoscopy revealed polypoid lesions in the cecum as well as blood throughout the colon, with no active source of bleeding. Surgery was considered for ongoing bleeding, however, because biopsies were negative for malignancy and positive on acid-fast stain, he continued conservative management with blood transfusions and anti-TB therapy. GI bleeding decreased significantly within the first 2 weeks, and resolved by day 25. He completed 1 year of anti-TB therapy, with no signs of colitis detected radiographically at the 6-month mark. Conclusions To our knowledge, this is the first report of GI bleeding as a very late manifestation of colonic TB, resolved with anti-TB therapy alone. Time from initial evidence of intestinal TB on imaging to the first bleed was 159 days, and time from initial symptoms was 6 months. As polypoid lesions are the least common gross finding on colonoscopy, a high degree of suspicion should be held in the right clinical setting. Surgical management should be considered only after conventional anti-TB therapy has failed. Funding Agencies None

1514 Intestinal Tuberculosis Presenting as GI Bleed and Cecal Mass

INTRODUCTION: Abdominal tuberculosis (TB) is rare and comprises only 5% of all cases of TB. Lower GI bleeding occurs in 5-15% of patients with intestinal TB, with the ileocecal region is the most common site of hemorrhage. We present a case of disseminated TB with intestinal involvement, presenting as a GI hemorrhage and cecal mass. CASE DESCRIPTION/METHODS: A 72-year-old female of Vietnamese origin with PMH of dementia and chronic hepatitis C presented to our hospital with a chief complaint of increased somnolence and melena. She was febrile, hypotensive, and tachycardic. Labs showed a hemoglobin of 6.2 and hematocrit of 20.3. She was admitted to the ICU for presumed sepsis due to a UTI, and was initiated on broad spectrum antibiotics. She was transfused packed red blood cells, and treated with IV pantoprazole and IV octreotide. Ultimately she underwent an EGD which was unremarkable. Subsequent workup with a chest CT revealed innumerable non-calcified bilateral lung nodules concerning for granulomatous disease. She underwent a bronchoscopy, and BAL was positive for AFB on cultures. Anti-TB therapy with rifampin, isoniazid, pyrazinamide and ethambutol was initiated. Due to ongoing encephalopathy an MRI of the brain was performed and showed multiple enhancing nodules suggestive of disseminated or metastatic disease. Ultimately a CT abdomen pelvis was performed showing a possible cecal and ascending colon mass with ileal thickening in the R pelvis. Subsequently a colonoscopy was performed which revealed an ulcerated non-obstructing mass at the ileocecal valve, with oozing and stigmata of recent bleeding. Biopsies showed granuloma formation with necrosis, with acid-fast bacilli confirmed on AFB stain. DISCUSSION: Intestinal TB is rare in Western countries and has a higher incidence in migrant populations. Its nonspecific features make establishing a diagnosis difficult. It should be considered in the differential diagnosis of GI hemorrhage in the appropriate clinical setting. As the presentation of colonic TB often mimics that of a neoplasm, colonoscopy with tissue biopsy remains the main stay of diagnosis.

A study on right iliac fossa mass

Background: Patients with mass in the right iliac fossa may confront the surgeon, pediatrician or gynecologist. Thus, thorough understandings of the anatomy and pathological process that may occur within the abdomen are essential for an accurate diagnosis and plan of treatment. The objective of this study was to interpret aetiopathology, clinical presentation, differential diagnosis and management of mass in the right iliac fossa.Methods: A total of 60 cases with mass in the right iliac fossa (RIF) were included in the study. Investigations like colonoscopy and CT scan were done. All the cases underwent right hemicolectomy followed by chemotheraphy. Other cases like psoas abscess, non-hodgkins lymphoma, Meckels diverticulum and intussusception were diagnosed and treated.Results: During this study period, a total number of 36 cases of appendicular mass and 10 cases of appendicular abscess were encountered. In this study 10 cases of appendicular abscess were encountered and treated by extraperitoneal drainage, 4 cases of ileocaecal kochs were encountered. Patients presented with constitutional symptoms like pain, fever, weight loss etc. Right hemicolectomy was done, specimens after operative procedures were examined microscopically and histopathological diagnosis. 3 cases of carcinoma caecum and 3 cases of carcinoma ascending colon were seen. Contrast enema was done which showed filling defect and mucosal irregularities.Conclusions: This study showed that appendicular mass is the commonest pathology in right iliac fossa amongst all and conservative treatment followed by interval appendicectomy is the best mode of treatment. Carcinoma of the colon and ileocaecal tuberculosis is the other two common causes for mass in the right iliac fossa. These cases also carry a good prognosis, if properly diagnosed and treated. The other rare causes of mass in the right iliac fossa are intussusception, psoas abscess and Non Hodgkins lymphoma.

Synchronous Colon Carcinoma and Tuberculosis: Coincidence or Linked.

How to cite this article: Dayal S. Synchronous Colon Carcinoma and Tuberculosis: Coincidence or Linked. Euroasian J Hepato-Gastroenterol 2017;7(1):97-98.

Role of Colonoscopy in Differentiating Intestinal Tuberculosis from Crohn’s Disease

ABSTRACT Background: The interface between tuberculosis (TB) and Crohn’s disease (CD) is relevant as TB complicates both the diagnosis and management of CD. Aim: This study aimed to identify the distinctive characteristics of ileocaecal and colonic TB (C‑TB) and colonic CD (C‑CD) at colonoscopy and to correlate the colonoscopy findings with histology. Materials and Methods: This prospective study included consecutive patients presenting with classical symptoms of TB or CD. The colonoscopic findings were compared with histology, which was taken as gold standard. Appropriate statistical tests were applied. Results: Fifty‑eight individuals fulfilled the inclusion criteria. Nine and 16 patients with C‑TB and C‑CD, respectively, had histological confirmation of respective diagnosis. In 33 specimens, the histological diagnosis was inconclusive. The sensitivity of colonoscopy for diagnosing C‑TB was high at 88.9% (95% confidence interval [CI]: 51.8–99.7). It was 50% (95% CI: 24.7–75.4) for CD. The reverse was true for CD whose specificity was high at 71.4% (95% CI: 55.3–84.3) and low for TB at 46.9% (95% CI: 32.5–61.7). All the patients diagnosed as confirmed CD or TB responded well to respective treatment. Six of the thirty patients with failed response to anti‑TB treatment required surgery or change in treatment after 2 months. Conclusion: Colonoscopic findings of isolated ileal involvement, aphthous ulcer, cobble stoning, long‑segment strictures, skip lesions and perianal involvement favored a diagnosis of CD. Correlation of colonoscopy with histology is poor for both CD and TB. The accuracy, sensitivity and specificity of colonoscopy were better and superior for the diagnosis of CD, than in the diagnosis of TB.

Believability of new diseases reported in the 2014 Surgeon General's Report on smoking: Experimental results from a national survey of US adults.

Tobacco use is the leading cause of preventable disease and death globally. The 2014 Surgeon General's Report included new diseases linked to smoking, including liver and colon cancer, diabetes and tuberculosis. As more diseases are linked to smoking, which diseases should we communicate to the public and what message source has the most impact? Data were collected through a nationally representative phone survey of US adults (N=5014), conducted from September 2014 through May 2015. We experimentally randomized participants to a 2 (new smoking disease messages - liver and colon cancers compared to diabetes and tuberculosis) by 4 (message sources - CDC, FDA, Surgeon General, and none) experiment. The outcome was message believability. About half the sample was female (51.5%) and 17.8% were a current smoker. Overall, 56% of participants said the messages were very believable. Cancer messages (liver and colon cancer) were significantly more believable than messages about chronic disease (tuberculosis and diabetes), 61% vs. 52%. Smokers were less likely to report both sets of new disease messages as very believable compared to non-smokers. Significantly more smokers intending to quit (44.5%) found the messages to be very believable compared to smokers not intending to quit (22.6%). Believability did not differ by message source. Important differences exist in believability of disease messages about new tobacco-related information. Messages emphasizing the causal link between smoking and new diseases should be considered for use in mass media campaigns.

Colonic tuberculosis

A 22-year-old previously healthy Ethiopian woman was admitted with a history of colicky lower-abdominal pain associated with vomiting, diarrhea, fever, night sweats, and unintentional weight loss. CT showed mildly dilated proximal small-bowel loops with air fluid levels, with mesenteric lymphadenopathy and congestion, associated with right iliac fossa fat stranding and bowel wall enhancement. Colonoscopy demonstrated multiple submucosal lesions extending from the splenic flexure to the ascending colon (A and B). The lesions extruded white chylous fluid during biopsy (C and D), which suggested a cystic nature. Multiple biopsy specimens were taken from the cyst wall, and the cyst content was sent for culture and cytology. Histopathologic examination revealed submucosal fibrosis with foci of inflammatory cells and ill-defined granulomas on deeper levels; Ziehl-Neelsen staining showed acid-fast bacilli (AFB). A sputum smear for AFB was negative; however, culture from the cyst aspirate was positive for Mycobacterium tuberculosis. Cytology was unremarkable.

Primary Tuberculous Stricture of Splenic Flexure of Colon

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge as the nonspecific features of the disease may lead to diagnostic delays and the development of complications. Tuberculosis of gastrointestinal tract commonly affects distal ileum and ileocaecal junction. Segmental colonic tuberculosis is uncommon and constitute 9.2 % of all abdominal tuberculosis. We are presenting a case of primary tuberculous stricture of splenic flexure which posed a diagnostic dilemma.

A Lethal Case of Sphingomonas paucimobilis Bacteremia in an Immunocompromised Patient.

Sphingomonas paucimobilis is a yellow-pigmented, glucose nonfermenting, aerobic, Gram negative bacillus of low pathogenicity. This organism was found in the implantation of indwelling catheters, sterile intravenous fluid, or contaminated hospital environment such as tap and distilled water, nebulizer, ventilator, and hemodialysis device. A 55-year-old female was hospitalized for diabetic foot ulcer in the presence of multiple comorbidities: diabetes mellitus, colonic tuberculosis, end-stage renal disease, and indwelling catheters for central venous catheter and hemodialysis. The patient passed away on the 44th day of admission due to septic shock. The organism found on blood culture on the 29th day of admission was multidrug resistant S. paucimobilis. Severe infection and septic shock due to S. paucimobilis have been reported particularly in immunocompromised patients, but there has been only one reported case of death in a premature neonate with septic shock. This is the first reported lethal case of S. paucimobilis bacteremia in an adult patient.