Gastrointestinal tuberculosis. A case report

We report a case of gastrointestinal manifestation of tuberculosis (TB). A 52 year-old female patient was admit ted into another hospital with unspecified gastrointestinal complaints. A computer tomography (CT) and a coloscopy showed a mild stenosis in the ileocecal region. The routine pulmonary X-ray showed a nodule, the cytology of the sputum was positive for tuberculosis. The patient was therefore transferred to our hospital. Following the anti-tuberculostastic treatment, the patient's abdominal condition improved but the symptoms reappeared weeks later. A sonography showed biliary calculus. Three days after endoscopic cholecystectomy the patient was discharged to home care and medical therapy. Four days later, she was admitted again with signs of subileus. Oral gastrografin solved the problem. The patient refused another coloscopy. Another 13 days later the patient was admitted once more with signs of an acute ileus. An emergency laparotomy with resection of the ileocoecal region was performed because of a complete stenosis. The histology showed a gastrointestinal tuberculosis. The patient had a smooth postoperative recovery and was released on the tenth day. She was on anti-TB therapy for 12 months without any complaints. In July 1999 the tuberculostatic treatment was stopped. It has been pointed out in numerous scientific publications that the clinical picture can be untypical and uncharacteristic, so that only the principal integration of TB in the differential diagnosis can allow the correct diagnosis. Surgical therapy should only be performed in emergency cases. In normal cases, medical therapy is the adequate treatment for tuberculosis.