Gastrointestinal Tuberculosis

ILEOCAECAL TUBERCULOSIS (Types)
Ulcerative type Hyperplastic type
Secondary to Pulmonary TB, when the patient swallows
infected sputumIncreased virulence & decrease host defense
Multiple circumferential transverse (girdle) ulcers with skip lesions
The serosa is studded with tubercles
Diarrhea, blood in stools, loss of appetite and weight
Histology: caseating granuloma with giant cells
Barium study — ileal(Napkin ring strictures) strictures with hypermotility
Primary GIT TB, drinking of infected milk
Decreased virulence & increase host defense
Hyperplasia and thickening of terminal ileum causing narrowing and obstruction of the lumen
Strictures and fibrosis
Presents as RIF mass
Can be confused with Crohn's disease (but abscess and fistula are rare )
Barium study: caecum pulled upto sub-hepatic position, obtuse ileocaecal angle
Other clinical features
  • Doughy fell of the abdomen
  • Ileocecal tuberculosis is associated with megaloblastic anemia
  • Localized areas of ascites
  • Multiple fistula-in-ano with undermined edges and watery discharge(diarrhoea)
  • Stellate ulcer with elevated margins is seen in Ileocecal tuberculosis 
  • Ileocaecal region is the most common site of abdominal TB due to
  1. Stasis of luminal contents favored by ileo-caecal valve
  2. Abundant Peyer's patches
  3. Bacterial contact time with mucosa is more
  4. M cells in Payer's patches phagocytose bacilli & transfer to host cell
DIAGNOSIS:
  • Barium study
  • Earliest signs — increased transit time; hypersegmentaion (chicken intestine), flocculation of barium
  • Narrow ileum with thickened incompetent ileocaecal valve — inverted umbrella sign or Fleischner sign
  • Hurrying of barium due to rapid flow and lack of barium in inflamed segment — Steirlin sign
  • Incompetent ileocaecal valve, ileocaecal spasm
  • Obtuse obliterated ileo-caecal angle
  • Ulcers and strictures in the terminal ileum and caecum - Napkin lesions
  • Persistent narrow stream (string sign)
  • Multiple strictures with enormous dilatation of proximal ileum (mega ileum)
  • Straightening of ileocaecal junction with 'goose neck' deformity
USG features of abdominal TB
  • Loculated ascites with fine septae
  • Interloop ascites with alternate echogenic and echofree areas — Club-sandwich appearance
  • Bowel loop radiates from its mesenteric root — Stellate sign
  • Mesenteric thickness > 15 mm
  • Pulled up caecum — Pseudokidney sign
  • Perforation is rare in intestinal TB 
Exam Question
  • Ileocecal tuberculosis presents with Rapid emptying of narrowed terminal ileum
  • Ileocecal tuberculosis shows Inverted umbrella sign
  • Stellate ulcer with elevated margins is seen in Ileocecal tuberculosis 
  • Hyperplastic tuberculosis is Mass in rt iliac fossa
  • Ileo caecal region is the Common site for Hyperplastic tuberculosis
  • In Hyperplastic tuberculosis x-ray shows indrawing of caecum from ileum
  • Ileocecal tuberculosis is associated with megaloblastic anemia
  • Small intestinal tuberculosis can cause Diarrhoea & stricture
  • Commonest site of tuberculosis of the intestines is illeum
  • Most common site of tuberculosis in gastrointestinal tract is Ileocecal junction
  • Pulled up cecum ,Obliteration of angle between ileum and cecum ,Narrowing of distal end of cecum are seen in ileocaecal tuberculosis

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