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*

BACKGROUND/AIMS: The incidence of Crohn's disease (CD) has been steadily increasing in Korea due to westernized life style and widely used imaging studies such as colonoscopy. There were few studies about the status of longterm trend of CD and intestinal tuberculosis (IT). Therefore, we aimed to evaluate the trend of CD and IT in Korea. METHODS: We retrospectively reviewed the medical records of newly diagnosed 65 patients with CD and 54 patients with IT at Chonnam National University Hospital between January 1998 and August 2007. RESULTS: Between 1998 and 2002, 16 and 40 patients were newly diagnosed as having CD and IT respectively, but between 2003 and 2007, 39 and 14 patients were newly diagnosed as having CD and IT respectively. CD patients (28.2+/-15.2 years) were younger than IT (46.2+/-18.5 years) (p=0.001). The male to female ratio of CD and IT were 2:1 and 1.1:1, respectively. The most common symptom of CD and IT was abdominal pain. Longitudinal ulceration, hyperemia, luminal narrowing, pseudopolyp, and cobble stone appearance were more common in CD than in IT (p<0.05). CONCLUSIONS: While the incidence of CD has increased, the incidence of IT has fallen over the last decade.
Adolescent ; Adult ; Age Factors ; Aged ; Crohn Disease/*diagnosis/*epidemiology/pathology ; Endoscopy, Gastrointestinal ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Tuberculosis, Gastrointestinal/*diagnosis/*epidemiology/pathology

Tuberculosis (TB) is a still prevalent and important disease entity in Korea. TB can involve any part of the gastrointestinal tract, and intestinal TB is an important disease of extra-pulmonary TB. The diagnosis of intestinal TB remains a challenge because the signs and symptoms are nonspecific. It should be differentiated from the inflammatory bowel diseases and malignancies, especially Crohn's disease. The diagnosis of intestinal TB should be based on careful clinical evaluation, such as extra-intestinal signs, colonoscopic and histologic evaluation. Newer techniques such as PCR method or test for the diagnosis of latent TB (Interferon-gammaassay) may be helpful. In addition, a high index of suspicion must be kept in mind to ensure a timely diagnosis. Herein, IBD Study Group of the KASID proposes a diagnostic guideline based on currently available evidence and experience, especially those of Korea. We also propose the test which may be helpful to establish the proper diagnosis of intestinal TB.
Blood Chemical Analysis ; Colonoscopy ; Diagnostic Imaging ; Humans ; Interferon-gamma/analysis ; Polymerase Chain Reaction ; Tuberculosis, Gastrointestinal/*diagnosis/pathology

Occult bleeding of the gastrointestinal tract is a major cause of iron deficiency anemia. Even with endoscopic evaluation of the upper and the lower gastrointestinal tract in these patients, in 30~50% of the cases, the cause of bleeding still remains undiscovered. Wireless capsule endoscopy (WCE) is a novel method of evaluating the small bowel mucosa by using a small capsule equipped with a camera and transmission device. Complications of WCE include impaction within the gastrointestinal tract, sometimes requiring surgical removal. The authors report a case of capsule impaction in the small bowel in a patient evaluated for anemia due to occult gastrointestinal tract bleeding. The patient is a 19 year-old female with a history of anemia since age 4. The stool guaiac test was positive, but upper and lower gastrointestinal tract endoscopy showed no abnormalities, so WCE was done. A short segment of circular ulcers with lumen narrowing were seen in the distal jejunum. Seven days after ingestion of the capsule, the patient denied passage of the capsule. Small bowel enteroclysis was performed, and the capsule was seen along with a segment of lumen narrowing distal to the site of retention. Surgery was done, and upon laparoscopic examination, the entire bowel appeared normal. Retrieval of the capsule was done along with a resection of an 8 cm segment of the small bowel. Three linear ulcers were seen in the resected bowel specimen. Pathology revealed no evidence of Crohn's disease or tuberculosis. The patient is still on iron supplements, but her hemoglobin level remains stable at 11~12 g/dl.
Anemia ; Anemia, Iron-Deficiency ; Capsule Endoscopy* ; Crohn Disease ; Eating ; Endoscopy ; Female ; Gastrointestinal Tract ; Guaiac ; Hemorrhage ; Humans ; Iron ; Jejunum ; Lower Gastrointestinal Tract ; Mucous Membrane ; Pathology ; Tuberculosis ; Ulcer ; Young Adult

Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis and should be differentiated from the inflammatory bowel diseases and malignancy such as Crohn's disease, ulcerative colitis, amebic colitis, and colon cancer. Most frequently involved sites (75% of cases) are the terminal ileum and cecum. Other sites of involvement, in order of frequency, are ascending colon, jejunum, appendix, duodenum, stomach, esophagus, sigmoid colon, and rectum. Intestinal tuberculosis simultaneously involving the stomach and colon has been very rarely reported. Recently, we experienced a case of synchronous gastric and colonic ulcers with granulomatous inflammation. Although we did not find acid fast bacilli and the culture test was negative, empirical anti-tuberculosis therapy resulted in dramatic clinical and endoscopic improvement. We report a rare case of multifocal gastrointestinal tuberculosis with a review of literature.
Colonic Diseases/*diagnosis/pathology ; Colonoscopy ; Drug Therapy, Combination ; Female ; Gastroscopy ; Humans ; Middle Aged ; Stomach Diseases/*diagnosis/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/*diagnosis/drug therapy/pathology

OBJECTIVE: We wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings. MATERIALS AND METHODS: There were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a retrospective review. CT imaging evaluation was done in each case, including the findings of a mass versus nodule, wall thickening (uniform or irregular) and the enhancement patterns (homogeneous or heterogeneous). RESULTS: All the cases of gallbladder TB revealed the following three different CT findings: micronodular lesion of the gallbladder wall (n = 1), a thickened wall (n = 4) and a gallbladder mass (n = 2). There were three cases of homogeneous enhancement of the lesions, including homogeneous enhancement with nodular lesion, homogeneous uniform thickness enhancement and homogeneous thickness enhancement in one case each, and these cases pathology showed tuberculous granuloma with a little caseating necrosis in one case and tuberculous granuloma with rich fibrous tissue, but little or no evident caseating necrosis in two cases. Four cases of heterogeneous enhancement of the lesions, including heterogeneous uniform-thickness enhancement in two cases, heterogeneous enhancement with a local mass lesion in one case and heterogeneous enhancement with a mass that replaced the gallbladder in one case; in these cases, pathology showed tuberculous granuloma with marked caseation or liquefaction necrosis in three cases and tuberculous granuloma by fibrous and calcifications accompanied by caseating necrosis in one case. Among the seven cases of gallbladder TB, six cases were accompanied by abdominal extra-gallbladder TB, including abdominal lymph node TB in five cases and hepatic TB in four cases. CONCLUSION: Gallbladder TB has various CT manifestations, and the enhanced CT findings are well matched with pathological features. An irregularly thickened gallbladder wall or a gallbladder wall mass with multiple-focus necrosis or calcifications accompanied by the typical CT findings of abdominal extra-gallbladder TB should suggest the diagnosis of gallbladder TB.
Adult ; Aged ; Female ; Gallbladder Diseases/pathology/*radiography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Tuberculosis, Gastrointestinal/pathology/*radiography

Tuberculosis may affect primarily all organs and tissues of the body, although some of these show high immunity against the infection. The most common forms of non-pulmonary tuberculosis are tuberculosis of bones and joints (30%), urinary system (24%), lymph nodes (13%), sexual organs (8%), cerebrospinal meninges (4%), and alimentary system (3%). Especially, the commonest presentation of abdominal tuberculosis is ileocecal disease, but isolated appendicular involvement is also rarely seen, occuring in only 1.5% to 3% of cases in the absence of pulmonary or other abdominal involvement. The appendix may either be involoved secondary to ileocecal tuberculosis, or to tuberculosis at another site within the abdomen, or may occur in the even, rarer "isolated" form, without the evidence of disease elsewhere. We report a case of acute appendicitis underwent appendectomy and histopathologic examination of appendix revealed appendicular tuberculosis.
Acute Disease ; Adult ; Appendectomy ; Appendicitis/*diagnosis/etiology/pathology ; Diagnosis, Differential ; Female ; Humans ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/*diagnosis/pathology/surgery

No abstract available.
Adult ; Colonic Neoplasms/diagnosis ; Colonoscopy ; Diagnosis, Differential ; Humans ; Ileal Diseases/*diagnosis/pathology ; Male ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/*diagnosis/pathology

OBJECTIVETo analyze the characteristics of intestinal tuberculosis(ITB) and primary small intestinal lymphoma(PSIL) in order to provide clue for the differential diagnosis.

METHODSData of 24 cases of ITB and 23 cases of PSIL confirmed by surgery and pathology were retrospectively analyzed. The clinical features, endoscopic and CT scan were compared. All the patients had complete clinical and CT data. Twenty cases of ITB and 20 PSIL had complete endoscopic data.

RESULTSITB was associated with significantly higher proportion of patients with fever(58.3% vs. 4.3%), night sweating(50.0% vs. 8.6%), pulmonary tuberculosis(54.2% vs. 4.3%) and ascites(54.2% vs. 21.7%) than PSIL(all P<0.05), and lower proportion of patients with abdominal mass (4.2% vs. 39.1%), hematochezia (8.3% vs. 47.8%), and perforation (0 vs. 39.1%)(all P<0.01). Endoscopic examination showed circumferential ulcer and rodent ulcer in 40% and 35% of the patients with ITB, and massive lesion and polypoid lesion in 55% of the patients with PSIL(P<0.05). Multi-segmental lesions, layered thickening, pneumatosis intestinalis, edematous ring, bowel lumen narrowing, hollow lymph nodes, and comb sign were more common in ITB(P<0.05), while single segmental lesions, eccentric thickening, and intussusception were more common in PSIL(P<0.05). The enhancement of intestinal wall of ITB were higher than that of PSIL(P<0.05), while the thickening and lymph nodes enlargement of PSIL were higher than that of ITB(P<0.05).

CONCLUSIONThe clinical characteristics differ between ITB and PSIL and the differential diagnosis can be made by combining endoscopy and CT.

Diagnosis, Differential ; Endoscopy ; Humans ; Intestinal Neoplasms ; diagnosis ; Intestine, Small ; pathology ; Lymphoma ; diagnosis ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal ; diagnosis

BACKGROUND: Since the pathologic findings of Crohn's disease (CD) and intestinal tuberculosis (IT) overlap to a large degree, the development of other biomarkers will be of great help for making the differential diagnosis of these 2 diseases. The aim of the present study is to examine the clinical efficacy of using the tissue angiotensin converting enzyme (ACE) assay in making the differential diagnosis between CD and IT. METHODS: Tissue specimens were obtained from 36 patients who were diagnosed with CD or IT by the colonoscopic biopsy, as well as by the clinical findings. The expression of tissue ACE was detected by immunohistochemical staining. The optimal cut-off value of the immunoreactive scoring (IRS) system we used to differentiate CD from IT was determined by analysis of the ROC curve and AUROC. RESULTS: Granuloma was present in 15 of 19 patients with CD (78.9%) and in 15 of 17 patients with IT (88.2%). ACE was present in the cytoplasm of the epithelioid cells in the granulomas from 13 of 15 patients with CD and in 14 of 15 patients with IT. The IRS scores of ACE were greater in the patients with CD than that of the patients with IT (8.07+/-4.38 vs. 4.13+/-2.47, respectively, p=0.006). In differentiating CD from IT, the AUROC curve for the IRS of ACE was 0.767 with a sensitivity of 66.7%, a specificity of 93.3% and the cut-off point was 7.5. CONCLUSIONS: The results of our study suggest that the assessment of the tissue ACE expression can be helpful for making the differential diagnosis between CD and IT.
Tuberculosis, Gastrointestinal/*diagnosis/enzymology/pathology ; Retrospective Studies ; Peptidyl-Dipeptidase A/*metabolism ; Middle Aged ; Male ; Immunoenzyme Techniques ; Humans ; Granuloma/pathology ; Female ; Diagnosis, Differential ; Crohn Disease/*diagnosis/enzymology/pathology ; Colonoscopy ; Biological Markers ; Aged ; Adult ; Adolescent