Small Bowel Tuberculosis Research Articles

Gender Prevalence and Management of Small Bowel Tuberculosis at Tertiary Care Hospital Nawabshah

Introduction: Abdominal tuberculosis has higher incidence particularly in developing countries. The challenge to Surgeon is to diagnose it as its presentation is very vague and diagnostic tools are dubious.1 Biochemical analysis helps a little bit in this regard. The abdominal tuberculosis which is not so commonly seen as pulmonary TB can be a source of significant morbidity and mortality and is usually diagnosed as late due to its non specific clinical presentation. About 15 to 25% of cases with abdominal tuberculosis here concomitant pulmonary TB.2 Any part of GIT can be affected but it is usually small bowel and sometimes a colon which is affected barium study has some role in diagnosing the ileal tuberculosis and then is on laparoscopic examination.3 Patients and Methods: This is a cross sectional study conducted at People Medical College Hospital Nawabshah. It was conducted in Surgical Unit 1 from January 2019 to December 2021. All the patients admitted in the ward came through OPD or through emergency. History was taken and proper examination of abdomen apart from systemic examination was done. Routine investigations were done. specific investigations like Liver function test (LFT) and serum electrolytes were done. Radiological investigations like ultrasound and x ray chest abdomen in erect and supine posture were done. Diagnosis was made and surgical intervention was done. Results: Total 30 patients were included in this study. Age of patients was between 20-50 years. 9(30%) patients aged between 20-3- years. 10 (33.3%) were of age between 31-40 years and 11 were aged between 41-50 years. Higher prevalence was in 4th and 5th decade of life. Patients with acute emergency were treated by Exploratory Laparotomy. Per operative findings showed stricture in 14 (47%) patients that were treated with resection and end to end anstomosis. 13 (43%) patients had single as well as multiple perforations of more than 4-5 cm in sizes with contamination of contents in abdominal cavity. Covering ileostomy was made in these patients. 3 (10%) patients’ perforations were of .5 to 1 cm with lesser contamination of abdominal cavity. Primary repair was made in these patients. Conclusion: It is concluded that Higher prevalence was in 4th and 5th decade of life. Its prevalence in female is higher as compared to male. .Majority of the patients with Abdominal Tb were treated by resection and end to end anastomisis. Keywords: Prevalence , Gender, Abdominal Tuberculosis, Resection, Anastomosis.

A case of small bowel tuberculosis with difficulty in diagnosis

A case of small bowel tuberculosis with difficulty in diagnosis

Comparison of virtual computed tomography enteroscopy using carbon dioxide with small-bowel enteroclysis and capsule endoscopy in patients with small-bowel tuberculosis.

Comparison of virtual CT enteroscopy (VCTE) using carbon dioxide with small-bowel enteroclysis (SBE) and capsule endoscopy (CE) in small-bowel tuberculosis (SBTB). This prospective study comprised consecutive patients suspected to have SBTB. VCTE and SBE were performed on the same day and evaluated by independent radiologists. CE was performed within 2 weeks. VCTE was performed following insufflation of carbon dioxide via catheters in the jejunum and anorectum. A contrast-enhanced CT was followed by a delayed non-contrast CT. Image processing was done using virtual colonoscopy software. Findings on VCTE, SBE, and CE were compared. The final diagnosis of SBTB was based on either histopathological or cytological findings, response to antitubercular treatment, or a combination of these. Of the 55 patients in whom VCTE was performed, complete data was available in 52 patients. A final diagnosis of SBTB was established in 37 patients. All patients had VCTE and SBE. CE was performed in 34 patients. Adequate luminal distension was achieved in all patients with SBE and 35 patients with VCTE. SBE showed more strictures in jejunum (10.8%) and ileum (75.7%) compared with VCTE (jejunum, 8.1%, and ileum, 64.9%) and CE (jejunum, 5.9%, and ileum, 61.8%). However, difference was not statistically significant. VCTE revealed a greater length of strictures in both the jejunum and ileum compared with SBE and CE. VCTE allows adequate evaluation of the bowel in most patients with SBTB. It allows detection of greater length of abnormality in jejunum and ileum compared with SBE and CE. • The use of VCTE using CO2 bowel insufflation in patients with SBTB should be considered. • VCTE allows detection of a greater length of abnormality in the jejunum and ileum.

Capsule Endoscopy for Obscure Gastrointestinal Bleeding: A Single‑Center Experience

ABSTRACT Background: Capsule endoscopy (CE) has an established role in evaluating obscure gastrointestinal bleeding (OGIB). The aim was to know the diagnostic yield of CE and spectrum of OGIB. Materials and Methods: In this retrospective study, we evaluated all the patients with obscure gastrointestinal bleed using MiroCam capsule endoscope (IntroMedic, Seoul, Korea) between February 2014 and March 2018. Clinical data, ancillary investigations, and response to specific treatment were considered to confirm CE findings. Results: Out of 102 patients included in the study (mean age 54.5 ± 16.1 years, male: female ratio = 1.83:1) OGIB‑overt and OGIB‑occult was present in 46 and 56 patients, respectively. Diagnostic yield of CE was similar in both the groups (overt‑37/46, 80.4% versus occult‑37/56, 66.5%) (P ≥ 0.05), although there was trend to find more lesions in overt group. Overall positive diagnostic yield was 72.5%. Lesions detected were vascular malformations in 21 (20.5%), nonsteroidal anti‑inflammatory drug enteropathy in 13 (12.7%), small bowel ulcerations in 27 (26.4%), which were further divided into three subgroups (a) nonspecific ulcerations 11 (10.7%), (b) tubercular ulcer with/without stricture in 7 (6.8%) and (c) serpiginous ulcers and fissuring with cobble‑stone appearance suggestive of Crohn’s disease in 9 (8.8%), portal hypertensive enteropathy in 5 (4.9%), worm infestation (hookworms in 3, roundworms 1) in 4 (3.9%), and small bowel tumour in 1 (0.98%) patient. Overall, 56.7% patients were having definitive (P2) lesions (Saurin classification). Two patients had retention of capsule, but none developed intestinal obstruction. Capsule was removed with surgical intervention. Conclusion: CE has high diagnostic yield, relative safety and tolerability, and it is an important diagnostic tool for OGIB. Small bowel tuberculosis, Crohn’s disease and Worm infestation continue to be commonly recognized causes of OGIB in developing countries like India.

Capsule endoscopy in small bowel Crohn's disease and Tuberculosis.

Differentiation of small bowel tuberculosis (SBTB) from Crohn's disease (CD) is a diagnostic challenge. We studied 52 patients with suspected SBTB or CD with terminal ileal involvement, who were prospectively enrolled. After confirming patency of the gastrointestinal tract, 26 patients underwent capsule endoscopy (CE). A final diagnosis of CD was found in 18 patients and SBTB in eight patients. All SBTB patients had involvment of the ileocecal valve (ICV) with large (n = 6) and aphthous (n = 2) ulcers in the ileal segment. In CD, ICV involvement was seen in five (33%) patients. Large and aphthous ulcers were observed in seven (47%) and 15 (100%) patients, respectively. On comparison with CD, patients with SBTB had increased frequency of ICV involvement ( P = 0.002) and lesser frequency of aphthous ulcers ( P = 0.007). CE can help in differentiating CD from SBTB by the position of its involvement and the type of ulcers present.

Muskuloskeletal Ultrasound Finding in Disseminated Tuberculosis

To describe ultrasound finding of musculoskeletal manifestation in disseminated tuberculosis. This descriptive study was conducted as a public–private mix approach at some least health facilities: Fanayama Community Health Centre, Lukas Goverment Hospital, Stella Maris Hospital, under coordination of South Nias Ministry of Health, Teluk Dalam, North Sumatera during May-July 2015. All patients had musculoskeletal sign and symptoms, in addition to disseminated tuberculosis including peritoneal (dry type) small bowel tuberculosis, chronic cough (lung tuberculosis suspected), neck lymph nodes enlargement and mild fever. The only available portable black and white ultrasound with convex probe 3,5 m Hz was performed on musculoskeletal affected area as well as abdominal ultrasound on tympanic and dullness abdominal pain area according to ‘dam board phenomenon’ of peritoneal dry type – small bowel tuberculosis. N = 2, (9 and 11 y) boys. Musculoskeletal ultrasound finding were thickening of the muscle and synovial of painful affected area in addition to several ovale/round nodular structures (patchy hyper-echoic non-shadowing with an irregular rim of lower echo-density). Small bowel ultrasound showed hypo-peristaltic, irregular thickening heterogenic hypo-echoic of the small bowel wall in addition to similar several ovale/round nodular structures (patchy hyper-echoic non-shadowing with an irregular rim of lower echo-density); loss differentiation of the wall layers, irregular margin and narrowing of the lumen were examined on the dullness pain area. No X-ray available. Follow-up after anti tuberculosis treatment showed improvement both clinically with ultrasound. Ultrasound of musculoskeletal manifestation in disseminated tuberculosis cases had some characteristics.

Ultrasound of Peritoneal and Small Bowel Tuberculosis among Mental Illness Patients

Ultrasound of Peritoneal and Small Bowel Tuberculosis among Mental Illness Patients

Extrapulmonary Tuberculosis in Children (Ultrasound Finding)

To describe ultrasound of extrapulmonary tuberculosis in children. This descriptive study conducted at very low economy and low hygiene sanitation environment at rural boundary islands: Saumlaki Health Centre, Tanimbar, Moluccas (January, 20-23. 2009 and March - May 2010), St Elisabeth Hospital, Flores, Nusa Tenggara Timur (February 2012 - August 2013) and Stela Maris, Lukas Hilisimetano Hospitals and Fanayama Primary Health Centret, Onohondro Village at South Nias–North Sumatera province (April- July 2015). Data were abstracted from medical records of children disseminated tuberculosis. Patients were diagnosed by one certified ultrasound internal medicine specialist using the only one black and white portable ultrasound available. Patients had never previously received medical specialist service nor ultrasound examination. N=724 children , 0,5-15y (Saumlaki 392, Flores 184 and South Nias 148). All (100%) were Peritoneal (dry type) with recurrent colic abdomen pain, diarrhea/obstipation, distention, doughy & dam-board phenomena as well as constitutional symptom and undernourished. Small bowel ultrasound showed a/hypo- peristaltic, irregular thickening heterogenic hypo-echoic, irregular margin of the wall, loss differentiation of the wall layers, with several oval/round nodular structures those suggestive granuloma. 100% Lymph node enlargement both neck and paraaortal. Kidney ultrasound images according to the kidney during childhood growth. Normal pancreas and urinary bladder. At South Nias: Musculoskeletal manifestation were 2 (1,4%). Peritoneal dry type and small bowel tuberculosis and lymph node enlargement were the most extrapulmonary tuberculosis, followed by musculoskeletal.

Ultrasound of Peritoneal (Dry Type) and Small Bowel Tuberculosis among HIV-AIDS

Ultrasound of Peritoneal (Dry Type) and Small Bowel Tuberculosis among HIV-AIDS

Small bowel tuberculosis by multidetector CT enteroclysis

To prospectively evaluate the role of multidetector computed tomography (CT) enteroclysis in evaluation and diagnostic characterization of suspected small bowel tuberculosis. The study group included 21 human subjects suspected of having small bowel tuberculosis. A nasoenteric tube was positioned into the duodenojejunal junction under fluoroscopic guidance and water was infused by hand injection. After intravenous administration of 120mL of iodinated contrast material, multidetector CT enteroclysis images were obtained with 40×0.625mm collimation and findings were analyzed by three readers working in consensus. Findings were compared with the results of endoscopy, histopathological analysis, and clinical follow up. Multidetector CT enteroclysis was well tolerated in 20 patients; one of the patients complained of vomiting during intubation. Using multidetector CT enteroclysis diagnosis of abdominal tuberculosis was made in sixteen patients, out of which small bowel involvement was seen in 13 patients. Multidetector CT enteroclysis demonstrated Crohn's disease in one patients and normal in four patients. The sensitivity and specificity in diagnosing abdominal tuberculosis by CT enteroclysis came out to be 93.75 and 100% respectively. Multidetector CT enteroclysis is well tolerable and accurate modality for evaluation and diagnostic characterization of small bowel tuberculosis.

Possible antistenotic effect of tranilast in a patient with small bowel tuberculosis to prevent intestinal obstruction due to stenosis progression by antituberculous chemotherapy

Small intestinal tuberculosis is a rare disorder of the small intestine. We report the development of deep small bowel tuberculosis in a rheumatoid arthritis patient who was taking methotrexate. The diagnosis of small bowel tuberculosis was ascertained by typical endoscopic findings and production of interferon gamma in the peripheral blood. The patient was successfully treated with antituberculous chemotherapy combined with an antifibrotic agent, tranilast, to suppress the progression of intestinal stenosis toward symptomatic stricture.

Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4%) and ileal typhoid perforation (26.4%), each followed by small bowel tuberculosis (10.3%) and stomach perforation (9.2%), perforation due to acute appendicitis (5%). The highest number of perforations was seen in ileum (39.1%), duodenum (26.4%), stomach (11.5%), appendix (3.5%), jejunum (4.6%), and colon (3.5%). Overall mortality was 13%. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup.

Isolated small bowel tuberculosis with stricture diagnosed by capsule endoscopy

Isolated small bowel tuberculosis with stricture diagnosed by capsule endoscopy

CAPSULE ENDOSCOPY FOR OBSCURE GASTROINTESTINAL BLEEDING IN THE TROPICS: REPORT FROM INDIA

Capsule endoscopy (CE) is useful in patients with obscure gastrointestinal bleeding (OGIB). Experience in CE in OGIB in the tropics is limited. Eighty-six patients with OGIB were evaluated clinically and using CE (Given Imaging, Yoqneam, Israel) 89 times (twice in three patients) during a 64-month period. Images were downloaded and examined by a single investigator using software (Rapid Reader; Given Imaging, Yoqneam, Israel). Patients received specific treatment and were followed up. Intraoperative findings, response to specific treatment and outcome on follow up (10.3±14.1 months) were considered to confirm CE findings. Of 86 patients (aged 54.5±16.3 years, 63 males), 64 and 22 had OGIB-overt and OGIB-occult, respectively. Lesions were equally detected in OGIB-overt and OGIB-occult patients (48/64, 75% vs 18/22, 81.8%, P= ns). Lesions were detected in 64 of 86 (74.4%) patients [vascular malformations with or without fresh bleeding in 24 (37.5%), tumors in 12 (18.8%), strictures in 15 (23.4%), ulcers in five (7.8%), hookworm in five (7.8%), and more than one lesion in three patients (4.7%)]. Endoscopic insertion of the capsule was required in four patients, and in six it was retained, although none developed intestinal obstruction (surgical removal in two). The sensitivity, specificity, positive and negative predictive values of CE to detect the lesion(s) were 92.9%, 68.2%, 84.8%, and 83.3%, respectively. CE is safe and is equally effective in detecting lesion(s) in occult and overt OGIB. Worm infestation and small bowel tuberculosis are unique and important causes of OGIB in the tropics.

A Case of Adult Intussusception Induced by Intestinal Tuberculosis

Intussusception primarily occurs in children and is uncommon in adults. Moreover, intussusception caused by intestinal tuberculosis is very rare. We report a case of intussusception induced by intestinal tuberculosis. A 53-year-old man presented to our hospital with complaints of cough and sputum for 2 weeks. We started anti-tuberculosis medication as the patient’s sputum acid-fast staining was positive. After 4 days of treatment, the patient developed abdominal cramping pain. Imaging studies showed ileo-ileal type intussusception. The patient underwent segmental resection of the small bowel and intestinal tuberculosis was confirmed on histological examination. He recovered after surgery and was discharged on anti-tuberculosis medication.

Abdominal tuberculosis: a panoramic view

Tuberculosis can involve almost any part of the gastrointestinal tract and the latter is considered the sixth most frequent site of extrapulmonary involvement. The most common site of involvement of gastrointestinal tuberculosis is the ileocaecal region. Ileocaecal and small bowel tuberculosis presents with a palpable mass in the right lower quadrant and/or complications of obstruction, perforation or malabsorption, especially in the presence of stricture. Useful modalities for investigating a suspected case include small-bowel barium meal, barium enema, ultrasonography, computed tomographic scan and colonoscopy. Ascitic fluid examination reveals straw-coloured fluid with high protein, serum/ascites albumin gradient less than 1.1g/dl, predominantly lymphocytic cells, and adenosine deaminase levels above 36 U/l. Laparoscopy is a very useful investigation in doubtful cases. Management is with conventional antitubercular therapy for at least 6 months. The recommended surgical procedures are conservative and a period of preoperative drug therapy is controversial.

Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience

BackgroundPerforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome.MethodsA prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK) Pakistan, from 1st September 2005 – 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled.ResultsThe most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6%) and gastric ulcer 1.3%. followed by small bowel tuberculosis (21%) and typhoid (17%). large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%). Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%).ConclusionThe spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular. Malignant perforations are least common in our setup.

Small bowel tuberculosis diagnosed by the combination of video capsule endoscopy and double balloon enteroscopy

Small bowel tuberculosis is sometimes encountered in oriental countries, and because its symptoms are vague and present a nonspecific pattern, confirmative diagnosis is difficult to achieve. In 2001, two new innovative endoscopic techniques for the small bowel, video capsule endoscopy and double balloon enteroscopy, were introduced, thus advancing the diagnostic technology for small bowel disorders. Our asymptomatic patient with small bowel tuberculosis was diagnosed definitively using the combination of video capsule endoscopy and double balloon enteroscopy. The number of such cases will increase when those procedures become more widely used. At present, the endoscopic view of small bowel tuberculosis is difficult to differentiate from Crohn's disease and drug-induced enteropathy, but from now on it will be possible to distinguish them utilizing endoscopic and fluoroscopic images. On the basis of the characteristics of small bowel tuberculosis with its endoscopic images, referring to our case report and previous literature, we report a topical diagnostic procedure, the combination of video capsule endoscopy and double balloon enteroscopy.

Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients.

To prospectively evaluate multi-detector row helical computed tomographic (CT) enteroclysis for the depiction of small-bowel diseases. The study group included 107 patients who were suspected of having small-bowel tumor (n = 8), active inflammatory small-bowel disease (n = 18), unexplained gastrointestinal bleeding (n = 36), refractory celiac sprue (n = 14), and low-grade small-bowel obstruction (n = 31). A nasoenteric tube was positioned into the duodenojejunal junction by using fluoroscopic guidance and water was infused with a pressure-controlled pump. After intravenous administration of 120 mL of iodinated contrast material, multi-detector row helical CT enteroclysis images were obtained with 4 x 2.5 mm collimation (four detector rows and 2.5-mm section thickness). Multi-detector row helical CT enteroclysis findings were analyzed by two readers working in consensus. Findings were compared with the results of endoscopy, enteroscopy, videocapsule endoscopy, histopathologic analysis, or clinical follow-up. Multi-detector row helical CT enteroclysis was well tolerated in 106 patients; one patient complained of abdominal pain after the examination. Multi-detector row helical CT enteroclysis allowed the diagnosis of small-bowel masses (n = 21), active Crohn disease (n = 9), small-bowel tuberculosis (n = 2), small-bowel lymphoma complicating celiac disease (n = 4), and confirmed low-grade small-bowel obstruction (n = 12). Multi-detector row helical CT enteroclysis demonstrated normal findings in 60 patients. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of multi-detector row helical CT enteroclysis were 100%, 95%, 97%, 94%, and 100%, respectively. Multi-detector row helical CT enteroclysis allows depiction of small-bowel diseases in patients suspected of having small-bowel conditions.

Small bowel tuberculosis: enteroclysis findings.

We describe the radiologic appearances of small bowel tuberculosis as shown by enteroclysis. A total of 265 patients with proven small bowel tuberculosis seen over a period of more than one decade was evaluated. All patients had positive radiologic findings as shown on enteroclysis examination. Of the 265 patients with small bowel tuberculosis, 174 had isolated small bowel involvement with a normal ileocecal region, whereas 91 had associated noncontiguous involvement of the ileocecal region. The most common radiologic finding was the presence of strictures, noted in 62.7% of cases. Most strictures were short, concentric, and smooth in outline. These strictures were solitary or multiple and located mainly in the jejunum. Other radiologic findings were adhesions (21.8%), ulcerations (9.1%), and diffuse thickening of folds (6.4%). Complications noted were in the form of enteroliths, perforations, and fistulae. The radiographic findings of small bowel tuberculosis, although non-specific, may indicate tuberculosis in a high-risk population.