No abstract available.
Diagnosis, Differential ; Humans ; Intestinal Diseases/complications/*diagnosis ; Tuberculosis, Gastrointestinal/complications/*diagnosis ; Tuberculosis, Pulmonary/complications/diagnosis

The clinical manifestations of intestinal tuberculosis are non-specific. But, abdominal pain, low grade fever, weight loss, anorexia, and diarrhea are major symptoms of intestinal tuberculosis. Massive bleeding has been reported as a rare manifestation of intestinal tuberculosis. Massive hematochezia from intestinal tuberculosis has rarely been reported in the medical literature. Also, most of them were treated with anti-tuberculosis medication only or with surgery. We treated a case of intestinal tuberculosis presenting massive hematochezia with colonoscopic coagulation therapy and anti-tuberculosis medication. Here, we report a Korean man who presented with massive hematochezia from ileal tuberculosis and treated by endoscopic coagulation therapy.
Adult ; English Abstract ; Gastrointestinal Hemorrhage/*etiology/therapy ; *Hemostasis, Endoscopic ; Humans ; Ileal Diseases/*complications/diagnosis ; Male ; Tuberculosis, Gastrointestinal/*complications/diagnosis

BACKGROUND/AIMS: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. METHODS: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. RESULTS: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. CONCLUSIONS: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.
Adolescent ; Adult ; Aged ; *Biopsy, Needle ; *Colonoscopy ; English Abstract ; Female ; Humans ; Intestinal Diseases/*diagnosis ; Male ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Tuberculosis, Gastrointestinal/complications/*diagnosis ; Tuberculosis, Pulmonary/complications

A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation. Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen. Subtotal colectomy including segmental resection of ileum, about 80 cm in length, followed by exteriorization of both ends, was performed in an emergency basis. Despite all measures, the patient died on the sixth postoperative day. The exact relationship of fulminant amebic colitis and intestinal tuberculosis is speculative but the possibility of a cause and effect relationship exists. Fulminant amebic colitis may readily be confused with other types of inflammatory bowel disease, such as idiopathic ulcerative colitis, Crohn's disease, perforated diverticulitis and appendicitis with perforation. This report draws attention to the resurgence of tuberculosis and amebiasis in Korea, and the need for the high degree of caution required to detect it.
Journal Article ; Diagnosis, Differential ; Dysentery, Amebic/surgery ; Dysentery, Amebic/pathology* ; Dysentery, Amebic/diagnosis ; Dysentery, Amebic/complications ; Fatal Outcome ; Human ; Male ; Middle Age ; Tuberculosis, Gastrointestinal/surgery ; Tuberculosis, Gastrointestinal/pathology ; Tuberculosis, Gastrointestinal/complications*

Intestinal hemorrhage, perforation, obstruction, and fistula formation are the common complications associated with intestinal tuberculosis. However, these complications usually occurr in active stage of intestinal tuberculosis. A 45-year-old man was diagnosed as intestinal tuberculosis and received anti-tuberculosis medications for 9 months. After the end of treatment, intestinal lesion was cured. However a deformed appendiceal orifice due to hypertrophic sear resulting in symptomatic appendictis was noted. We report a case of acute appendicitis due to intestinal stricture after the successful treatment of intestinal tuberculosis.
Acute Disease ; Antitubercular Agents/therapeutic use ; Appendicitis/*diagnosis/etiology/surgery ; Colonoscopy ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/complications/*drug therapy

Pseudomembranous colitis (PMC) is known to be associated with the administration of antibiotics which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. Most cases of rifampicin-induced PMC are seen in patients with pulmonary tuberculosis, but not with gastrointestinal tuberculosis. We report a case of PMC associated with rifampicin therapy in a patient with gastrointestinal tuberculosis. A 65-year-old female patient with rectal cancer and gastrointestinal tuberculosis was admitted due to abdominal pain and diarrhea. She was treated with anti-tuberculosis agents containing rifampicin. On colonoscopic examination, mucoid exudates and yellowish plaque lesions were observed. Anti-tuberculosis agents were stopped, and the patient was treated with metronidazole. Symptoms were relieved and did not recur when all the anti-tuberculosis agents except rifampicin were started again. When a patient complains of abdominal pain or diarrhea while taking rifampicin, the physician should consider the possibility of rifampicin-associated PMC.
Aged ; Antibiotics, Antitubercular/*adverse effects/therapeutic use ; Enterocolitis, Pseudomembranous/*diagnosis/etiology/pathology ; Female ; Humans ; Rectal Neoplasms/*complications/diagnosis ; Rifampin/*adverse effects/therapeutic use ; Sigmoidoscopy ; Tuberculosis, Gastrointestinal/complications/diagnosis/*drug therapy

PURPOSE: This study was undertaken to investigate the preoperative diagnosis, indication for operation, postoperative complication, postoperative medical treatment and recurrence rate in patients with Crohn's disease who were treated with operation. METHODS: Forty patients with Crohn's diseases had been operated on at the Department of Surgery, Yonsei University College of Medicine during the period from Jan 1986 to May 1999 and they were reviewed retrospectively. We studies symptoms, surgical indications, preoperative and postoperative treatments, involvement sites, types of operation and recurrence rate in Crohn's disease. RESULTS: The male to female ratio was 1.5: 1, and age distribution was from 8 to 69 years old with mean age of 33 years old. The duration of symptoms varies from within 1 day to above 10 years and most of them had within 1 month as 17 cases (42.5%). Symptoms are abdominal pain, hematochezia, anorexia, abdominal mass and diarrhea. The most frequent symptom was the abdominal pain as 85%. Crohn's disease was diagnosed only 45% before operation, less than what we expected. In another hand it surprised us find out that tuberculosis enteritis was diagnosed as much as 20%. The most common indication of operation was medical treatment failure as 13 cases, and fistula was 7 cases, intestinal obstruction with stenosis and tumor were 6 cases each other. The involvement of small bowel was most common as 40%, and the most common operative findings were ulceration and fistula for 17 cases and 12 cases respectively. Small bowel cases were treated with segmental resection and anastomosis in all 16 cases. Large bowel cases were performed right hemicolectomy in 10 cases and total colectomy in 1 case. Both small and large bowel involvement cases, right hemicolectomy was done in 4 cases, right hemicolectomy and segmental resection of small bowel was done in 6 cases. The recurrence rate of postoperative medical treatment was 16% and 28% for 5 years and 10 years respectively. The recurrence rate with no postoperative medical treatment was 13% and 26% for each 5 years and 10 years. There was no significantly difference in both groups. CONCLUSION: The major surgical indications for Crohn's disease were medical treatment failure, fistula and intestinal obstruction. Specially in Korea, differential diagnosis with tuberculosis enteritis was very important. Postoperative complication and recurrence rate has relatively low incidence. Our study suggest that postoperative medical treatment was controversial.
Abdominal Pain ; Adult ; Age Distribution ; Aged ; Anorexia ; Colectomy ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Diagnosis, Differential ; Diarrhea ; Enteritis ; Female ; Fistula ; Gastrointestinal Hemorrhage ; Hand ; Humans ; Incidence ; Intestinal Obstruction ; Korea ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Treatment Failure ; Tuberculosis ; Ulcer