- Causes:Tuberculosis of the Intestine is caused by Mycobacterium tuberculosis, the same bacteria that cause pulmonary tuberculosis. It primarily affects the intestines when the bacteria spread through the bloodstream or lymphatic system from other sites of infection, such as the lungs. Risk factors include immunocompromised states, malnutrition, and close contact with individuals with active tuberculosis.
- Presentation: Intestinal tuberculosis presents with nonspecific symptoms, including abdominal pain, weight loss, fever, diarrhea, and occasionally gastrointestinal bleeding. These symptoms can mimic other gastrointestinal disorders, making diagnosis challenging.
- Investigation: Diagnosis involves a combination of clinical suspicion, imaging studies (such as CT scans and endoscopy), and microbiological tests (such as acid-fast bacilli staining and cultures). Tissue biopsy is often necessary to confirm the diagnosis, revealing characteristic granulomas.
- Diagnosis: Intestinal tuberculosis is diagnosed based on clinical findings, imaging studies, microbiological tests, and histopathological examination of biopsy samples. Given its nonspecific presentation, a high index of suspicion is crucial for timely diagnosis and initiation of treatment.
- Treatment: Standard treatment involves a regimen of first-line anti-tuberculous drugs, including isoniazid, rifampicin, pyrazinamide, and ethambutol, administered for several months. Surgery may be necessary in cases of complications such as obstruction, perforation, or strictures.
Tuberculosis can infect the lungs, but it can also affect the intestines. It is a chronic disease of the walls of the intestine, which are characterized by tubercle deposits. Common manifestations of the disease are in the form of single tubercles, ulcerations and clumps of tubercles. Its symptoms are almost similar to Crohn’s disease. Tuberculosis of the Intestine can affect any part of the gastrointestinal tract. The most commonly affected part is the ileocecal region in the right upper quadrant. GI tuberculosis is mostly found in developing or underdeveloped countries. People with tuberculosis of the intestine are susceptible to HIV infections.
Intestinal TB is classified into three categories:
Ulcerative form :These are multiple superficial ulcers restricted to the epithelial surface and a very active form of the disease.
Hypertrophic form :These thicken the bowel wall creating scarring and fibrosis. It has a rigid appearance and looks like a carcinoma.
Ulcerhypertrophic form :This is a combination of ulcerative and hypertrophic forms.
Abdominal Tuberculosis Causes
There are two types of conditions causing intestinal tuberculosis; primary and secondary. Primary can be due to direct intake of infected food and secondary could be due to any other tubercular infection into the blood stream. Prolonged pulmonary tuberculosis can cause complications of the intestine.
- Hematogenous spread
- Ingestion of infected sputum
- Spread from infected and contagious lymph nodes
- Spread from contagious fallopian tubes
Abdominal Tuberculosis Symptoms
- Abdominal pain
- Diarrhea
- Alternate constipation
- Abdominal distension
- Fever
- Weight loss
- Malabsorption
- Fistula
- Bowel obstruction
- Fatigue
- Diffuse abdominal tenderness
- Night sweats
Abdominal tb diagnosis
Blood tests: These help in detecting elevated levels of transaminases, ESR and detects anemia.
Tuberculin skin tests :This is a standard method of detection of mycobacterium tuberculosis infection.
Biopsy :A polymerase chain reaction or PCR test is done to show sensitivity and specificity levels.
Radiographs :Imaging of the abdomen, upper GI series, barium enema, computed tomography and ultrasonography of the abdomen are done.
Colonscopy and endoscopy :These are done with biopsy and sent for a culture test.
Abdominal Tuberculosis Treatment
It is usually difficult to differentiate between Tuberculosis of the Intestine and Crohn’s disease. Abdominal tuberculosis will require confirmation before treatment. ATT (Anti-Tuberculosis treatment) for 6 – 9 months is necessary for cure. At time surgery is required to relieve bowel obstruction.