Tuberculous Appendicitis Research Articles

Acute appendicitis due to extrapulmonary tuberculosis

Introduction and ImportanceTuberculous appendicitis is very infrequent, estimated to occur in only 0.1% of all appendectomies. Appendicular tuberculosis can manifest as either a primary or secondary infection. Primary appendicular tuberculosis is even more uncommon and occurs in the absence of any detectable primary focus elsewhere in the body. Case presentationIn this report, we present a challenging case of primary tuberculous appendicitis that does not appear to have originated from the lungs. This case highlights the importance of considering tuberculosis in the differential diagnosis of appendicitis, especially in regions where tuberculosis is endemic or in patients with a history of tuberculosis exposure. Clinical DiscussionDiagnosing tuberculous appendicitis can be challenging due to its rarity and the non-specific nature of its symptoms, which often mimic those of more common conditions such as acute appendicitis and because of these non-specific symptoms, tuberculous appendicitis is mostly diagnosed only after surgical intervention. ConclusionThis case underscores the need for a high index of suspicion and thorough diagnostic evaluation in patients with atypical presentations of appendicitis specifically in patients with chronic complaints. Treatment typically involves a combination of surgical intervention to remove the affected appendix and a prolonged course of anti-tuberculous medication to eradicate the infection and prevent recurrence.

Acute Tuberculous Appendicitis, a Rare Entity

Tuberculous appendicitis is a rare disease, with an overall incidence of between 1.5-3.0% among tuberculosis patients. It was first described by Corbin et al in 1873 and since then has been rarely recorded in publications and case reports. In the USA, extrapulmonary disease is seen in around 20-30% of tuberculosis patients, with the most common extrapulmonary manifestations being bone (30%), urinary tract (24%) and lymph node (13%) involvement. A high index of suspicion is required to make the diagnosis of appendicular tuberculosis, although it can cause damage to the appendix without other signs of localized disease. We report a case of a woman diagnosed with primary tuberculous appendicitis in a patient with human immunodeficiency virus (HIV), with evidence of extra-intestinal disease.

Granulomatous AppendicitisA Rare Case Report

In 1953, Meyerding and Bertram were the first person to report non specific granulomatous inflammation in appendix. Granulomatous appendicitis is a rare condition which usually account to less than 2% of the cases, however idiopathic granulomatous appendicitis is very rare, and diagnosis is usually made by excluding all other conditions. It is challenging to diagnose tuberculous appendicitis based on clinical findings, hence histopathological examination is required. Hereby, authors report a case of 26-year-old male who presented with pain abdomen in the Department of Surgery. On imaging, appendix was thickened, and acute appendicitis was considered as a probable diagnosis. On histopathological examination, it was diagnosed as granulomatous inflammation suggestive of tuberculosis. The present case is presented for its rarity as appendicitis is considered as an abdominal emergency, so prompt management and diagnosis is required by excluding all other causes of granulomatous inflammation in appendix.

Apendicitis xantogranulomatosa; un desafío diagnóstico: Caso Clínico

Introduction: Xanthogranulomatous inflammation is a chronic inflammatory process, rarely located in the appendix. A case of xanthogranulomatous appendicitis is presented. Clinical case. A 77-year-old male presents with intermittent pain in the right hemiabdomen and hyperthermia of one month's evolution. Physical examination showed a tumor in the iliac fossa and right abdomen. He underwent surgery for a probable incarcerated right inguinal hernia, acute perforated appendicitis was found, with inflammation and adhesions, purulent fluid in the right hemiabdomen and abdominal wall dissection. The histopathological result was xanthogranulomatous appendicitis. The evolution of the patient was favorable. Conclusion. Xanthogranulomatous appendicitis simulates a typical picture of acute appendicitis. Histopathologically, pathologies such as Crohn's disease, malacoplakia and tuberculous appendicitis were ruled out.

Tuberculous Appendicitis – A Rare Case Report

Gastrointestinal tuberculosis accounts for nearly 3 % of the total extra pulmonary cases. Tuberculous appendicitis is a rare type of gastro intestinal tuberculosis, seen only in 0.1 to 0.3% of cases. Here we present a tuberculous appendicitis case in a 20 year old female.

Acute Tuberculous Appendicitis with Intestinal Obstruction

Tuberculosis (TB) can involve any organs. Tuberculous appendicitis is a rare case. Incidence of primary tuberculous appendicitis is 0.1-0.3% while incidence of secondary tuberculous appendicitis is 1.5-3%. Tuberculous appendicitis occurs in 0.08% of all appendectomy and 0.2% of all TB cases. We reported an acute tuberculous appendicitis with intestinal obstruction. Diagnosis was established based on histopathological findings. Treatments included appendectomy and first category of anti tuberculosis drugs (ATD) for 6 months. This case was reported to add our insight about possibility of TB as an etiology of many pathologic conditions in abdominal cavity.

Tuberculosis extrapulmonar como apendicitis aguda tuberculosa

Introducción: La apendicitis es la emergencia quirúrgica abdominal más frecuente, pero la tuberculosis como agente etiológico hace especial este caso, debido a su muy baja frecuencia entre 0.1 al 0.6%, su hallazgo incidental nos orienta a buscar otros órganos comprometidos y a iniciar tratamiento específico, este es el primer reporte de caso en nuestra región.
 Método/Reporte de caso: Mujer de 33 años, con antecedentes de insuficiencia suprarrenal primaria, en tratamiento con fludrocortisona, quien consultó por presentar dolor en cuadrante inferior derecho abdominal, picos febriles y episodios eméticos, lo anterior asociado a biometría hemática con leucocitosis más desviación a la izquierda, uroanálisis patológico, se sospecha infección del tracto urinario, iniciando antibioticoterapia, sin obtener mejoría, por lo que se evalúa por cirugía general quien considera abdomen agudo de origen en apendicitis, realizando abordaje quirúrgico con posterior estudio histopatológico que sugiere inflamación granulomatosa caseificante compatible con tuberculosis, con la consecuente demostración de BAAR mediante tinción de Ziehl Neelsen.
 Conclusión: La tuberculosis extrapulmonar tiene presentaciones clínicas diversas, por lo tanto, debemos mantener sospecha ante manifestaciones atípicas de la patología, la apendicitis aguda tuberculosa, generalmente se da en el contexto de un paciente inmunosuprimido y su diagnóstico etiológico es realizado en el post operatorio, por lo tanto, es indispensable vigilar y revisar el resultado de la biopsia y las tinciones que nos permitan realizar tratamientos específicos.
 
 

The Role of PCR in Diagnosis of a Rare Appendicular Tuberculosis and Mini Literature Review.

Tuberculosis is a prevalent public health problem especially in the poor developing countries and results in significant mortality. Albeit tuberculosis almost always affects any organ or system of the body, abdominal tuberculosis is less frequent; moreover, tuberculous appendicitis is very rare with an incidence estimated at about 0.1–0.6% of all gastrointestinal tuberculosis. The purpose of this report was to present an unusual case of primary tuberculous appendicitis and the approach used for accurate diagnosis as well as a current update on the disease. We are reporting a 30-year-old male who presented with acute abdominal pain, fever, and vomiting and was admitted with the clinical diagnosis of acute appendicitis. Patient was investigated thoroughly and histopathologic examination was strongly suggestive of tuberculous appendicitis; however, Ziehl-Neelsen (ZN) was negative in tissue section. To confirm the diagnosis, molecular biology [polymerase chain reaction (PCR)] study was performed from the formalin fixed paraffin embedded (FFPE) appendicular tissue and revealed presence of Mycobacterium tuberculosis. As there are numerous differential diagnoses in granulomatous lesions of appendix and due to the fact that appendicular tuberculosis is a rare phenomenon; verification etiologic agent is crucial for appropriate management of the disease.

Tuberculous appendicitis: A rare case report

Tuberculosis (TB) in appendix is a very rare occurrence. Clinical diagnosis is often not possible. Histopathological examination confirms the diagnosis of tuberculous appendicitis. Postoperative antitubercular drug treatment is compulsory for management. We are presenting a case of TB of appendix, which was presented with acute abdomen and diagnosed in histopathological examination.

Primary Tuberculous Appendicitis: Rare Cause of a Common Disease

Gastrointestinal tuberculosis is quite rare, representing only 3% of all extrapulmonary cases. Primary tuberculosis of the appendix is a clinical rarity. It is usually secondary to tuberculosis elsewhere in the abdomen. Diagnosis is often made only after histopathological examination of the resected specimen. This report describes a 21 year old male with clinical diagnosis of acute appendicitis, who was finally diagnosed as tuberculous appendicitis as the histopathological examination revealed chronic granulomatous inflammation along with caseous necrosis. We made a diagnosis of primary tuberculosis of appendix and the patient was on anti-tuberculosis medication. This article stresses the importance of histopathological examination of the resected appendix.
 JCMCTA 2014 ; 25 (2) : 54-56

Primary tuberculosis of the appendix: A rare cause of a common disease

Tuberculosis is still a common infection in India. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. Our case report highlights a rare presentation of tuberculosis and a brief review of literature.

Primary tuberculous appendicitis presented with caecal perforation: A case report

Gastrointestinal tuberculosis accounts for 3% of the extrapulmonary tuberculosis with ileocaecal region being the common site of involvement up to 75%. Primary involvement of appendix is very rare and accounts for only 0.6% to 2.9% of gastrointestinal tuberculosis in the absence tubercular focus elsewhere. The pre-operative investigations usually give non-specific results. The diagnosis in most instances made only after histopathology. Here we report a case of primary appendicular tuberculosis in a patient presented with caecal perforation.

Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report

IntroductionTuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant.Case presentationA 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis.ConclusionOur case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians.

Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

To document unusual findings in appendectomy specimens. The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens. Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed. Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

A Case of Acute Appendicitis due to Appendicular Tuberculosis

The most common presentation of abdominal tuberculosis is an ileocecal disease, but isolated appendicular involvement is rarely seen. It is difficult to make diagnosis of intestinal tuberculosis because it may mimic many other intestinal diseases. The symptoms are nonspecific such as fever, fatigue and weight loss. A 35-yr-old woman with no remarkable past medical history was admitted due to intermittent abdominal pain of 3 mo duration. The patient underwent laparoscopy-assisted partial ileocecectomy including diseased appendix. Tuberculous appendicitis was finally diagnosed with all considerations of possible pathological results. We report a case of acute appendicitis due to tuberculous involvement with a review of the literature.

Multi-Detector CT Findings of Primary Tubercular Appendicitis: A Case Report

The frequency of intestinal tuberculosis is relatively common; however, primary tuberculosis of the appendix remains a rarity. We report on a case of primary tuberculous appendicitis for which we obtained the MDCT images revealing thickening of the appendix and the surrounding lymphadenopathies.

Acute isolated tuberculous appendicitis

Non-pulmonary tuberculosis is found with different frequencies in different countries of the world. It is said to constitute about 4% of all tuberculosis cases in Poland, about 25% in England and Wales and about 17% in the USA. It seems that these differences are the result of differences in rates of diagnosis and registration of new tuberculosis cases. This in turn is influenced by public health funding in the individual countries. In this work, we present a case of acute, isolated, tuberculous inflammation of the appendix. We call attention to the fact that pre-operative diagnosis is practically impossible. Clinical symptoms do not point to inflammatory changes. Only surgical evaluation, and especially the result of histopathological examination make it to possible to establish the final diagnosis to initiation of anti-tuberculous treatment.

Tuberculous Appendicitis in India

Tuberculous appendicitis (TBA) is a rare condition. The present study has been conducted to study its prevalence and presentation. This retrospective study was performed in the Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India, in 870 consecutive appendectomies performed between January 1991 and December 2000. Of 870 consecutive appendicular specimens, 10 cases of primary (1.1%) and 16 of secondary TBA (1.8%) were encountered. Results of all pre-operative investigations were non-specific and the diagnosis was made only after histopathology. The prevalence of TBA in this study was 2.9%. Although it is a rare condition, its possibility should be kept in mind by clinicians as well as pathologists. All surgically removed appendix specimens should be histopathologically examined, whether or not the specimens are macroscopically normal. Given antitubercular treatment in addition to appendectomy, patients recover without complications.

Tuberculous appendicitis with perforation

Tuberculous appendicitis with perforation