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home - Miscellaneous - Infection - TB Enteritis Written by Dr Sebastian Zeki

TB Enteritis

TB can affect the upper female reproductive tract (fallopian tube, endometrium, ovaries) by extension from an intraabdominal focus, hematogenous seeding, or ascending from lower genital tract (cervix, vagina, vulva) infection.The fallopian tube and endometrium are most commonly involved.The finding of endometrial TB always means that the tubes are infected but tuberculous salpingitis can exist without associated endometritis.A variety of clinical manifestations have been reported including a pelvic mass, infertility, abnormal uterine bleeding, and pelvic pain.In most cases, the diagnosis is made most readily by endometrial biopsy for histology and culture.Genital TB is an important cause of infertility in developing countries; in a report from India, it accounted for 7.5 % of 492 patients who underwent a hysterosalpinogram for evaluation of infertility.Even after treatment it is irreversible in 20% From infected milk (TB enteritis) The organism penetrates the mucosa and localizes in the submucosal lymphoid tissue, where it initiates an inflammatory reaction with subsequent lymphangitis, endarteritis, granuloma formation, caseation necrosis, mucosal ulceration, and scarring. Symptoms:Nonspecific chronic abdominal pain in 85%.Anorexia, fatigue, fever, night sweats, weight loss, diarrhea, constipation, or blood in the stool can be present.A palpable RLQ mass in 35%.Small bowel obstruction and colonic perforation. Macroscopic appearances:Ulcerative (60 %)- multiple superficial ulcers.(assoc with virulent clinical course).Hypertrophic (10 %)- scarring, fibrosis, and pseudotumor lesions.Ulcerohypertrophic (30 %)-inflammatory mass around the ileocecal valve with thickened and ulcerated intestinal walls (usually ileocaecal). Ileocecal most commonly involved due to relative stasis and abundant lymphoid tissue DiagnosisHistology and biopsy culture establishes diagnosis in up to 80 %.At endoscopy take samples from ulcer margins and bed (TB granulomas are submucosal).PCR of biopsy has ahigher sensitivity and specificity than routine culture and can get results in 48hrs.If the diagnosis is unclear, then an exploratory laparotomy is indicated.Empirical TB course and relaparotomy is indicated if there is no improvement in 2 weeks. Radiologic findingsImaging is non-specific and usually shows an ileitis.The most common CT finding is concentric mural thickening of the ileocecal region, with or without proximal intestinal dilatation.Asymmetric thickening of the medial caecal wall is occasionally seen.Characteristic lymphadenopathy with hypodense centers, representing caseous liquefaction, is present in the adjacent mesentery. ManagementAnti-TB drugs are usually very effective.Compliance is the best determinant of outcome.The surgical resection should be conservative.Multiple small bowel strictures are treated by strictureplasty to avoid major resection.Bypass surgery for obstructing lesions should be avoided because of complications of blind loop syndrome.An alternative is colonoscopic balloon dilation, which can be used to manage readily accessible, short and fibrous tuberculous ileal strictures causing subacute obstructive symptoms. TB Eneritis Genital TB Colonoscopic findingsIt looks very similar to CD apart from lesions tend to be more circumferential and are usually surrounded by inflamed mucosa.A patulous valve with surrounding heaped up folds or a destroyed valve with a fish mouth opening is more likely to be caused by TB than CD. Feature favouring TB overCrohn’s:TB granulomas are submucosal and large, confluent with caseation necrosisTB ulcers are lined by aggregate epithelioid histiocytes, and disproportionate submucosal inflammation is seen.CD granulomas are infrequent, small, nonconfluent, or noncaseating.Microgranulomas, focally enhanced colitis, and high prevalence of chronic inflamm-tion in endoscopically normal appearing areas also characterize CD. Ascites more common in TB than Crohn’s Surgery is indicated for complications:Free perforationConfined perforation with abscess or fistula,Massive bleedingComplete obstructionObstruction not responding to medical management.Obstruction most common complication; patients with multiple and/or long strictures are less likely to respond to medical therapy.Obstruction is exacerbated during antituberculous therapy due to healing by cicatrisation. Written by Dr Sebastian Zeki

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