Duodenal Involvement Research Articles

Cross-sectional Imaging of the Duodenum: Spectrum of Disease.

Cross-sectional Imaging of the Duodenum: Spectrum of Disease.

Post-Traumatic Duodenal Rupture at the Fousseyni Daou Hospital in Kayes, Mali: A Case Report

Lesions resulting from duodenal involvement are rare. Their diagnosis and management remain difficult because of the topographic location of most of the duodenum in the retroperitoneum. We report a case of isolated duodenal rupture. At the time of the first operation, the duodenal lesion had gone unnoticed. During our management, we discovered a rupture of the lower knee of the second duodenum and we performed a triple anastomosis after the closure of the ends (proximal and distal). The immediate postoperative course was complicated by the death of the patient on the second day of surgery. Duodenal lesions have much mortality which is increased by the delay in diagnosis and management.

Germ cell tumor with duodenal involvement: a rare case of gastrointestinal bleeding.

A 19-year-old male presented to the emergency department with a 7-day history of melena, anorexia and asthenia. Blood tests revealed a hemoglobin of 5.8 g/dL. Upper endoscopy showed a large ulcerated and stenosing lesion in the duodenum. The histologic examination of the biopsy specimen showed a neoplasia with epithelioid cells, accentuated atypia and pleomorphism, expressing MNF 116 cytokeratin, CD30, glypican 3 and alpha-fetoprotein on immunohistochemistry, suggesting of a germ cell tumor metastasis.

Iron Deficiency Anemia in Inflammatory Bowel Diseases-A Narrative Review.

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. IBD has been associated with numerous symptoms and complications, with the most common being iron deficiency anemia (IDA). Iron deficiency in IBD is caused by inadequate intake, malabsorption (including duodenal involvement and surgical removal), and chronic blood loss by mucosal ulcerations. Therefore, an appropriate diet should be enforced. Iron deficiency and iron supplementation have been associated with alterations to gut microbiota. IBD-associated anemia, in particular iron deficiency anemia, is associated with a significant decrease in quality of life and with clinical symptoms such as chronic fatigue, headaches and dizziness, reduced exercise tolerance, pale skin, nails, conjunctiva, and fainting. However, despite these numerous adverse symptoms, IDA remains undertreated. The European Crohn’s and Colitis Organisation (ECCO) guidelines state that patients should be monitored for anemia. Adequate treatment, whether oral or intravenous, should be implemented while taking into consideration C-reactive protein values (CRP), hemoglobin levels, and therapeutic response. It should be stressed that every case of anemia in IBD patients should be treated. Intravenous iron formulations, which are more superior compared to the oral form, should be used. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.

Gastrointestinal tract involvement in hepatocellular carcinoma: two cases illustrating duodenal and oesophageal invasion.

We present here two hepatocellular carcinoma (HCC) patients with gastrointestinal tract involvement (GITI). Hemorrhage due to duodenal involvement was the inaugural event of the HCC for the first patient. Dysphagia due to HCC recurrence in the oesophagus four years after left hepatectomy was the call symptom for the second. As incidence of HCC increases, and overall survival improves, incidence of GITI in HCC patients is expected to increase.

S3579 A Rare Case of Gastric and Duodenal Pseudomelanosis

Introduction: Pseudomelanosis gastri or gastric pseudomelanosis is an extremely rare endoscopic mucosal finding that has been reported on few occasions in the literature. We present a case of an incidental finding of extensive gastric and duodenal pseudomelanosis in an elderly female with symptomatic anemia. Case Description/Methods: A 71-year-old female with history of heart failure, diabetes mellitus, coronary artery disease, atrial fibrillation, hepatitis C, iron deficiency anemia, ovarian cancer and malignant peritoneal mesothelioma presented with lethargy and anorexia. Physical examination was remarkable for an epigastric mass and digital rectal exam revealed dark brown stool. Laboratory studies were notable for Hb 4.4, BUN 70, Cr 5.9 and elevated transaminases. Outpatient medication included eliquis, insulin, rosuvastatin, isordil, entresto, hydralazine, aspirin, amiodarone and iron supplementation. She received two units of blood and responded appropriately. CT abdomen/pelvis was significant for metastatic disease and a previously unchanged large pelvic mass. Esophagogastroduodenoscopy revealed patchy and diffuse discoloration in the gastric body and duodenum with no evidence of active bleeding or high-risk stigmata of bleeding. (Figure 1) Pathology was consistent with a diagnosis of pseudomelanosis in the stomach and duodenum with evidence of chronic atrophic gastritis. The patient’s hemoglobin remained stable and her Eliquis was held. With no evidence of active bleeding, she was discharged with plans for follow up in the outpatient setting for further evaluation with colonoscopy. Discussion: While the etiology is not well defined, pseudomelanosis of the upper gastrointestinal tract is classically associated with bleeding, diabetes mellitus, end stage renal disease, antihypertensives such as hydralazine and oral iron take. Our case had numerous risk factors that are suggested to cause pseudomelanosis and while duodenal involvement has been well described there have been very few cases reporting the presence in both the stomach and duodenum. Pseudomelanosis is a benign condition of no known clinical significance however it is important for an endoscopist to be aware of this entity as it can appear very similar to malignant melanoma on both endoscopy and histology and therefore must be differentiated. It may also become a more common finding due to an aging population with multiple comorbidities on medication associated with the diagnosis and thus must be recognized.Figure 1.: Gastric Pseudomelanosis.

Intrahepatic Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography: Potential Imaging Signature for Protein-Losing Enteropathy in Congenital Heart Disease.

BackgroundProtein‐losing enteropathy (PLE) is a significant cause of morbidity and mortality in congenital heart disease patients with single ventricle physiology. Intrahepatic dynamic contrast‐enhanced magnetic resonance lymphangiography (IH‐DCMRL) is a novel diagnostic technique that may be useful in characterizing pathologic abdominal lymphatic flow in the congenital heart disease population and in diagnosing PLE. The objective of this study was to characterize differences in IH‐DCMRL findings in patients with single ventricle congenital heart disease with and without PLE.Methods and ResultsThis was a single‐center retrospective study of IH‐DCMRL findings and clinical data in 41 consecutive patients, 20 with PLE and 21 without PLE, with single ventricle physiology referred for lymphatic evaluation. There were 3 distinct duodenal imaging patterns by IH‐DCMRL: (1) enhancement of the duodenal wall with leakage into the lumen, (2) enhancement of the duodenal wall without leakage into the lumen, and (3) no duodenal involvement. Patients with PLE were more likely to have duodenal involvement on IH‐DCMRL than patients without PLE (P<0.001).ConclusionsIH‐DCMRL findings of lymphatic enhancement of the duodenal wall and leakage of lymph into the duodenal lumen are associated with PLE. IH‐DCMRL is a useful new modality for characterizing pathologic abdominal lymphatic flow in PLE and might be useful as a risk‐assessment tool for PLE in at‐risk patients.

Comparison of the extent of pediatric inflammatory bowel disease based on endo-colonoscopy and histological findings

Introduction: Paris classification for the extent of inflammatory bowel disease (IBD) in children is based solely on macroscopic findings obtained via endo-colonoscopy. However, in some cases histologic findings may indicate more severe cases. Objectives: The aim of the present study was to compare the extent of pediatric IBD based on endo-colonoscopy and pathological findings. Patients and Methods: Data on 67 hospitalizations were collected from 51 children with IBD who had been admitted to the children’s medical center of Tehran. All patients underwent endoscopy or colonoscopy and had a histological report. Results: Comparison of the endoscopic and histological findings in ulcerative colitis showed that, in 37% of cases, gastric involvement was reported in histology, while these cases were reported normal in endoscopy. In colonoscopy, the transverse colon was more involved, as compared with the results of histology, while in other parts of the colon, the histological involvement showed more severe findings. Considering Paris classification, in 25% of cases, the extent of the disease was higher in colonoscopy, and in 16% of cases, it was higher in histology. Of all children with Crohn’s disease, gastric involvement in 20% of cases and esophageal and duodenal involvement in 13% of cases were more reported in histology than in endoscopy. In the ascending colon, descending colon, and rectosigmoid, histological involvement was more than that observed in colonoscopy. Considering Paris classification, in 5% of cases, the extent of the disease was higher in colonoscopy, and in 9% of cases, it was higher in histology. Conclusion: Concurrent use of histological findings and endoscopic findings may help to better determine the severity and extent of the disease and facilitate the process of treatment.

Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

BackgroundThere are no clearly defined indications for pancreas-preserving duodenectomy. The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreas-preserving duodenectomy. MethodsPatients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included. We divided the series according to indication: scenario 1, primary duodenal tumors; scenario 2, tumors of another origin with duodenal involvement; and scenario 3, emergency duodenectomy. ResultsWe included 35 patients. Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis, limited duodenectomy in 7, and third + fourth duodenal portion resection in 27. The indications for scenario 1 were gastrointestinal stromal tumor (n = 13), adenocarcinoma (n = 4), neuroendocrine tumor (n = 3), duodenal adenoma (n = 1), and adenomatous duodenal polyposis (n = 1); scenario 2: retroperitoneal desmoid tumor (n = 2), recurrence of liposarcoma (n = 2), retroperitoneal paraganglioma (n = 1), neuroendocrine tumor in pancreatic uncinate process (n = 1), and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage (n = 1); and scenario 3: aortoenteric fistula (n = 3), duodenal trauma (n = 1), erosive duodenitis (n = 1), and biliopancreatic limb ischemia (n = 1). Severe complications (Clavien-Dindo ≥ IIIb) developed in 14% (5/35), and postoperative mortality was 3% (1/35). ConclusionsPancreas-preserving duodenectomy is useful in the management of primary duodenal tumors, and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

Diagnosis and management of small intestinal injury due to percutaneous renal access

Define factors for proper diagnosis and treatment of small intestinal injury during procedures with percutaneous renal access, thus optimizing favorable outcomes and avoiding complications and death during conservative or surgical approaches. Bibliographic review of case reports available in the literature and presentation of data from an additional case have been carried out. Percutaneous nephrolithotripsy was the procedure that most frequently caused injury of the small intestine. Time for diagnosis of the lesion took up to 5days after the intraoperative phase. When occurring in the intraoperative phase, perforation was identified by direct endoscopic visualization; a catheter was then placed inside the intestinal lumen and a conservative approach to the derived fistula was adopted, which led to successful outcomes in all cases. Abdominal pain was the most common symptom in cases diagnosed during the postoperative phase (75%). In the presence of signs of peritonitis, surgical intervention was performed, with favorable evolution in all cases. Conservative management of small intestine injuries is possible when there is no peritoneal contamination. Its success factors include intraoperative diagnosis and non-transfixing lesions, which is more common in duodenal involvement. Laparotomy to clean the cavity associated with a corrective approach (enterorrhaphy or enterectomy with primary anastomosis) was successfully indicated in cases of late diagnosis with signs of peritonitis, a situation that is most commonly found in transfixing lesions of ileum and jejunum.

Schistosomiasis with Duodenal Involvement Presenting as Irritable Bowel Syndrome in a 9-Year-Old Patient

Abstract Introduction/Objective Schistosomiasis is extremely rare in the United States. Most patients diagnosed in the US have an international travel history or recently immigrated from endemic areas. We report a case of a 9-year-old boy who presented with a three-month history of daily abdominal pain, decreased appetite, weight loss, and microcytic anemia. The patient had alternating symptoms of constipation and diarrhea mimicking Irritable Bowel Syndrome (IBS). Methods CT scans showed distal sigmoid colon with wall thickening and hyperenhancement. Stool Helicobacter pylori antigen test was positive and hemoglobin levels were low (11 g/dL). The blood eosinophil count was initially within the normal range but was significantly elevated three months later (2,115 cells/µL). Esophagogastroduodenoscopy and colonoscopy were performed, which showed patchy areas of erythema and punctate bleeding within the descending and sigmoid colon. Results Gastrointestinal tract biopsies revealed focal, prominent eosinophilic infiltrates in the lamina propria. There were multifocal granulomas and fibrosis surrounding Schistosoma ova in the lamina propria and submucosa of duodenum, cecum, colon, and rectum. Acid-fast stain highlights the shell and spine of the ova. A retrospective chart review revealed that the patient had traveled to Yemen one month before the onset of symptoms. Schistosomiasis is among the top differentials for marked, sustained eosinophilia, especially with relevant travel history. Distortions caused by processing and sectioning can make speciation difficult on tissue sections. Acid-fast staining of the shell would favor S. mansoni over S. intercalatum; however, the S. intercalatum-S. hematobium hybrid also has an acid fast–positive shell. The duodenum is an uncommon location to find Schistosoma ova, which are usually found in the rectum and sigmoid colon. Conclusion The symptoms of gastrointestinal schistosomiasis may mimic IBS, and eosinophilia may initially be not evident as in this case. However, a high degree of suspicion is required in diagnosing schistosomiasis in patients from endemic areas.

Disseminated histoplasmosis with duodenal involvement

Disseminated histoplasmosis with duodenal involvement

Adult Langerhans cell histiocytosis presenting with multisystem involvement and sarcomatoid features: a case report

BackgroundLangerhans cell tumors are rare clonal disorders characterized by neoplastic proliferation of dendritic cells that can be further classified into the subtypes Langerhans cell histiocytosis and Langerhans cell sarcoma, which are rare neoplasms exhibiting aggressive features and a poor prognosis. In addition to illustrating the refractoriness and poor outcomes of multisystem Langerhans cell histiocytosis in adults, specific events in this case highlight important characteristics of disease biology that warrant detailed discussion and exposition to a wider audience.Case presentationWe describe the case of a 42-year-old Caucasian man with Langerhans cell histiocytosis diagnosed from a lesion on the left arm that presented with constitutional symptoms, early satiety, and weight loss. Esophagogastroduodenoscopy showed extensive esophageal and duodenal involvement by Langerhans cell histiocytosis with features of Langerhans cell sarcoma. He was initially treated for Langerhans cell histiocytosis with low doses of cytarabine until he eventually presented clear transformation to acute monoblastic leukemia with complex karyotype that could not be properly controlled, leading eventually to death.ConclusionsLangerhans cell histiocytosis remains an exceedingly rare entity in adults, frequently presenting as multisystem disease with risk organ involvement. Langerhans cell sarcoma represents an aggressive subtype with extremely poor prognosis for which intensive acute myeloid leukemia induction should be strongly considered.

Disseminated histoplasmosis with duodenal involvement

Disseminated histoplasmosis with duodenal involvement

Exploring the neglected segment of the intestine: the duodenum and its pathologies.

Herein we reviewed the computed tomography (CT) findings of a spectrum of pathological entities affecting the duodenum. We discuss the CT findings of some congenital, inflammatory, traumatic, and neoplastic pathologies of the duodenum along with the conventional barium studies of selected conditions. Pathologies of this C-shaped intestinal segment, derived from both foregut and midgut, are often overlooked in clinical practice and radiological literature. While congenital anomalies like duplication cysts and diverticula are usually asymptomatic, annular pancreas and malrotation may manifest in the first decade of life. Primary as well as secondary involvement of the duodenum by various disease processes can be evaluated by careful CT technique and proper attention to the duodenum. Among congenital conditions, annular pancreas, duplication cyst, superior mesenteric artery syndrome, midgut volvulus, and diverticula are presented. Duodenal involvement in adenocarcinoma, lymphoma, gastrointestinal stromal tumours, Crohn’s disease, and groove pancreatitis are discussed. Duodenal wall haematoma and traumatic duodenal perforation causing pneumoretroperitoneum in two patients after blunt trauma of the abdomen are also illustrated. CT provides superb anatomic detail and offers high diagnostic specificity for the detection of duodenal pathologies because it allows direct imaging of the intestinal wall, secondary signs of bowel disease within the surrounding mesentery, and abnormal findings in adjacent structures. Primary duodenal malignancies and local extension from adjacent malignancies can be diagnosed by CT reliably. CT also plays a vital role in the diagnosis of traumatic duodenal injury by differentiating between mural haematoma and a duodenal perforation because the latter requires immediate surgical intervention.

Another Whipple\u2019s triad? Pericardial, myocardial and valvular disease in an unusual case presentation from a Canadian perspective

BackgroundWhipple’s disease is a clinically relevant multi-system disorder that is often undiagnosed given its elusive nature. We present an atypical case of Whipple’s disease involving pan-valvular endocarditis and constrictive pericarditis, requiring cardiac intervention. A literature review was also performed assessing the prevalence of atypical cases of Whipple’s disease.Case presentationA previously healthy 56-year-old male presented with a four-year history of congestive heart failure with weight loss and fatigue. Notably, he had absent gastrointestinal symptoms. He went on to develop pan-valvular endocarditis and constrictive pericarditis requiring urgent cardiac surgery. A clinical diagnosis of Whipple’s disease was suspected, prompting duodenal biopsy sampling which was unremarkable, Subsequently, Tropheryma whipplei was identified by 16S rDNA PCR on the cardiac valvular tissue. He underwent prolonged antibiotic therapy with recovery of symptoms.ConclusionsOur study reports the first known case of Whipple’s disease involving pan-valvular endocarditis and constrictive pericarditis. A literature review also highlights this presentation of atypical Whipple’s with limited gastrointestinal manifestations. Duodenal involvement was limited and the gold standard of biopsy was not contributory. We also highlight the Canadian epidemiology of the disease from 2012 to 2016 with an approximate 4% prevalence rate amongst submitted samples. Routine investigations for Whipple’s disease, including duodenal biopsy, in this case may have missed the diagnosis. A high degree of suspicion was critical for diagnosis of unusual manifestations of Whipple’s disease.

Gastrointestinal involvement in patients with vasculitis: IgA vasculitis and eosinophilic granulomatosis with polyangiitis.

Background and study aims Among vasculitides, IgA vasculitis (IgAV) and eosinophilic granulomatosis with polyangiitis (EGPA) frequently damage the gastrointestinal tract. However, only a few studies have investigated the entire gastrointestinal tract in patients with IgAV or EGPA by endoscopy. The aim of this study was to clarify endoscopic characteristics of patients with IgAV and those with EGPA. Patients and methods Clinicopathological and endoscopic findings were retrospectively compared between 33 patients with IgAV and 19 patients with EGPA. Results Gastrointestinal involvement was observed in 33 patients with IgAV (100 %) and in 8 patients with EPGA (42 %; P = 0.0001). Duodenal involvement was more frequent in patients with IgAV (75.8 %) than in those with EGPA (21.1 %, P = 0.0002). Jejunoileal involvement was frequent in both groups (IgAV 94.4 %; EGPA 77.8 %). Gastric mucosal erythema was more frequent in patients with IgAV (18.2 %) than in those with EGPA (0 %, P = 0.0481). Duodenal mucosal erythema (IgAV 54.6 %; EGPA 21.1 %, P = 0.0227), ulcer (IgAV 33.3 %; EGPA 0 %, P = 0.0041), and hematoma-like protrusion (IgAV 21.1 %; EGPA 0 %, P = 0.039) were more frequently observed in patients with IgAV than in those with EGPA. Conclusions Frequent duodenal involvement, gastric mucosal erythema, and duodenal lesions including erythema, ulcer, and hematoma-like protrusion are characteristic of patients with IgAV. Because jejunoileal involvement was frequent in both groups of patients, small-bowel endoscopies should be performed for diagnosis of small-bowel lesions in patients with IgAV and EGPA.

1173 Patients Taking Proton Pump Inhibitors Are More Likely to Respond to Endoscopic Dilation of Benign Duodenal Stenosis, Regardless of the Etiology

INTRODUCTION: Benign duodenal stenosis (BDS) is usually managed by endoscopic balloon dilation (EBD), but there is very limited literature on this practice outcomes. We sought to investigate the etiological spectrum, response to EBD and predictors for successful EBD. METHODS: We performed a cohort study of a prospectively maintained database of benign duodenal stenosis at a tertiary referral center between 2013 and 2018. Pyloric stenosis patients were excluded. All patients that underwent EBD were analyzed. Dilation was performed using through the scope balloons. Technical and clinical success of initial and repeat EBD were compared among the BDS etiologies, location within the duodenum, and number of stenotic tracts. Logistic regression models were performed using SAS software. RESULTS: A total of 276 patients were analyzed, of whom 87 patients underwent EBD for BDS. Most common etiology was peptic ulcer disease (PUD) 42 (45%) (Table 1). Upon initial EBD, technical success was 96.5% and clinical success was 74.4%. Upon repeat EBD, technical success was 98.1% and clinical success was 78.7%. When comparing PUD vs. All others, initial clinical success was 77.8% vs. 71.4% (P = 0.52), and on repeat EBD clinical success was 72.0% vs. 86.4% (P = 0.23). When comparing Crohn’s disease vs. All others, initial EBD clinical success was 72.2% vs. 75.0% (P = 0.81), and repeat EBD clinical success was 91.7% vs. 74.3% (P = 0.20). When comparing location of the stenosis in the 1st portion of the duodenum vs. distal duodenum, initial EBD clinical success was 70.0% vs. 82.1% (P = 0.24), and repeat EBD clinical success was 75.0% vs. 78.7% (P = 0.36). When comparing single vs. multiple strictures, initial EBD clinical success was 73.0% vs. 100.0% (P = 0.57), and repeat EBD clinical success was 77.3% vs. 100.0% (P = 0.99) (Table 2). 15 patients underwent planned/prophylactic EBD, but this did not impact the outcomes. Males were more likely to have distal duodenum stenosis when compared to females (63.6% vs. 36.4%, P = 0.007). African American had a lower likelihood of clinical success (aOR 0.083, P = 0.004), and usage of PPI increased likelihood of clinical success (aOR 3.65, P = 0.04) (Table 3). CONCLUSION: EBD has very high technical and clinical success rates in BDS. Males tend to have more distal duodenal involvement; African Americans ethnicity are less likely to respond to EBD and importantly, PPI usage was an independent predictor for EBD clinical success regardless of etiology.

2553 A Rare Discovery of Duodenal Noncaseating Granulomas

INTRODUCTION: Duodenal involvement of sarcoidosis is infrequently reported. It can manifest with a spectrum of symptoms and mimic other gastrointestinal diagnoses. CASE DESCRIPTION/METHODS: This is the case of a 59-year-old man with a history of pulmonary sarcoidosis on hydrochloroquine and deep venous thrombosis on apixaban who presented with weight loss with associated abdominal pain, decreased appetite, early satiety, and intermittent dysphagia to both solids and liquids. He reported a colonoscopy 2 years prior that was normal. Labs were notable for a hemoglobin of 11.5 with an MCV of 77. CMP, TSH and HIV were normal. Physical exam revealed a thin male, unremarkable vital signs and normal cardiac, pulmonary and abdominal evaluations. He underwent upper endoscopy and was found to have white esophageal plaques suggestive of candidiasis, gastritis with gastric nodularity, and a normal duodenum. Gastric biopsies were consistent with gastritis with positive staining for H.pylori for which he was subsequently treated. He underwent abdominal CT revealing diffuse small bowel wall thickening and enlarged retroperitoneal and mesenteric lymph nodes. Decision was made to proceed with repeat upper endoscopy as well as endoscopic ultrasound. Upper endoscopy noted gastritis and new duodenitis. Gastric biopsies showed chronic gastritis, negative staining for H.pylori, and positive CD20 and CD3 staining consistent with a reactive process. Duodenal biopsies showed noncaseating granulomas and villous blunting (Figure 1). EUS was unrevealing except for peripancreatic and porta hepatis lymphadenopathy for which he underwent fine needle aspiration. Flow cytometry was negative. The patient was started on high dose steroids given the duodenal involvement of his sarcoidosis followed by a taper over a few months. During the taper, he returned with worsening anemia and diarrhea. Repeat upper endoscopy revealed more extensive involvement of the duodenum with severe inflammation and plan for outpatient colonoscopy and follow up with his sarcoidosis specialist to discuss treatment regimen. DISCUSSION: Although duodenal sarcoidosis is rare, it is important to include this in the differential diagnosis in the appropriate clinical setting. It's symptoms and pathology can have overlap with some common diseases such as celiac, Crohn's disease, and even lymphoma. Tissue acquisition is imperative to confirm the diagnosis and can be performed at the time of endoscopy with treatment aimed at management of the underlying disease process.

Isolated Gastro-Duodenal Tuberculosis Mimics Peptic Ulcer Disease in a Young Female

Intestinal tuberculosis (TB) most commonly affects ileo-caecal region. Isolated gastric and duodenal involvement without pulmonary infection is rare. The presentation of these patients varies. Patients may present with haematemesis, non-healing chronic ulcer, mimicking malignancy, gastric perforation and gastric outlet obstruction. High degree of suspicion is needed for early diagnosis of gastro-duodenal TB. A young female patient who was being treated as a case of nonhealing chronic ulcer was referred for treatment. Histopathological examination of endoscopic biopsy specimen of the patient showed presence of granulomas composed of epitheloid cells and Langhan’s giant cells with caseation with no evidence of tuberculosis at pulmonary or other body sites. After anti-tubercular chemotherapy there was resolution of symptoms and healing of ulcers. This case of isolated gastro-duodenal TB is reported for its rarity.&#x0D; J Enam Med Col 2019; 9(3): 189-192