Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients

Background: Colonoscopy with terminal ileoscopy is crucial for the diagnosis of intestinal tuberculosis. This report describes characteristic endoscopic findings in patients with intestinal tuberculosis with few or no clinical symptoms. Methods: Data for 11 consecutive patients in whom a diagnosis of intestinal tuberculosis was made during the last 15 years in one facility were reviewed. Clinical findings and the frequency of endoscopic findings were evaluated. Mucosal lesions were classified into 4 types: type 1, circumferential ulceration with nodules; type 2, round or irregularly shaped small ulcers, arranged circumferentially, without nodules; type 3, multiple erosions restricted to the large intestine; and type 4, small ulcers or erosions restricted to the ileum. The gross endoscopic appearance of healed lesions included patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal areas with aggregated ulcer scars. Results: Only one patient had remarkable clinical symptoms (anorexia and weight loss), whereas, the other 10 had few or no symptoms. The frequency of type 1, 2, 3, and 4 endoscopic findings was, respectively, 36%, 36%, 9%, and 18%. The frequencies for patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal area were, respectively, 45%, 45%, and 91%. Conclusions: When colonoscopy is performed in asymptomatic patients, it is important to be aware of subtle endoscopic findings that are characteristic for intestinal tuberculosis. Recognition of such findings may lead to a correct diagnosis of early stage intestinal tuberculosis.