Although Hippocrates noted the occurrence of diarrhoea in the later stages of phthisis, and stated that 'Phthisical patients die if diarrhoea sets in', and Aretaeus wrote in a similar vein, was not until the seventeenth century that tuberculosis of the intestine was written of as an entity. One of the earliest records is of the autopsy findings of Louis X I I I (x643) who had a large pulmonary cavity and intestinal tuberculosis (Viorordt). In I715, Brunner, quoted by Brown and Sampson, described a case of tuberculosis in which he found 6o separate ulcers in the gut. It was x8~5 before any extensive pathological studies were recorded, when Louis described how granulation tissue was found in the small gut, especially near the caecum, and how this went on to ulceration. Soon after, in I83o, Corbin noted a stage of healing in some of these ulcers which he described as scirrhus degeneration, and which gave rise to stenosis of the gut. In I84~ , Gerhard correlated the symptomatology and pathology of intestinal tuberculosis; he noted the intermittent nature of the symptoms arid that after a while, diarrhoea might cease and the follicles might cicatrize. But was left to Rokitansky in I845 , in his classical descriptions, to put the problem on a firm footing. Describing the pathogenesis of ulceration and the possibility of healing, he states, ' In consequence of contraction of the ulcer, a cicatrix forms, in the shape of an elevated ridge on the internal surface of the intestine. I f the ulcer is of considerable size, it diminishes the calibre of the gut'. He concludes 'the cure of tuberculous intestinal ulcer is ahvays accompanied by a diminution of the intestinal calibre'. Nevertheless, the development of stenosis with symptoms of obstruction would appear to be a rarity, although the symptoms may be mild enough to bc ignored, or may even be symptomless. Fraenkel describes a case in which 8 stenoses were found, but in which there were no symptoms. The finding is uncommon even at post-mortem. Thus Goldberg, Sweeny and Brcwn in n3o autopses found only two stenoses (both in colon). This rarity would at first appear to be difficult to explain, especially as intestinal ulcers appear to have a marked tendency to connective tissue formation with healing. Williams in a study of 3,693 cases concludes that at least io per ccnt should have a favourable prognosis, and Brown and Sampson record evidence of healing in 463 per cent of 194 cases examined. They suggest that the rarity is due to the fact that death usually supervenes once there is intestinal.involvement, before healing can occur to any great extent. The following cases arc presented because is felt that modern trends in treatment of tuberculosis have done much to make us question the Hippocratic aphorism. Diarrhoea is no longer of the same fatal portent, and one wonders whether the future holds for us increasing number of cases of obstruction following tuberculous ulceration.
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Apr 2, 2015
H C Huizing 
Open Access