Diffuse Fistulizing Small Bowel Disease Small Bowel Tuberculosis: Challenging Case to Diagnose

Alqahtani IN, Masharfeh YH and Bazeed FM

Published on: 2020-02-18

Abstract

Diffuse small bowel disease is considered challenging case for physicians to diagnosed especially if they saw multiple fistulae between the bowel loops and colon and patient was labeled as query inflammatory bowel disease. In this report we describe the condition of a 27 years old Saudi male, with no history of chronic health problem was referred to our hospital with history of intermittent abdominal pain lasted for three months with gradual onset. The pain nature was colicky especially at para-umbilical area. This pain was associated with nausea and anorexia with history of weight loss. The patient also gave history of vomiting frequently with progressive abdominal distention for the last month. Gastroscopy was done showed multiple duodenal ulcers but colonoscopy was normal. MR Enterography show diffuse small bowel thickening. Push enteroscopy was done showed dilated small bowel with extensive erythematous mucosa and scattered ulcers with multiple small bowel fistula. Tissue PCR for TB was positive. Patient was finally diagnosed as small bowel TB case. Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB) bacteria. (1) Tuberculosis generally affects the lungs, but can affect any part of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. The classic symptoms of active TB are a chronic cough with blood- containing sputum, fever, night sweats, and weight loss. In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as "extrapulmonary tuberculosis". Approximately 15%-25% of cases with abdominal TB have concomitant pulmonary TB. Hence, it is quite important in identifying these lesions with high index of suspicion especially in endemic areas. The abdominal TB usually occurs in four forms: tuberculous lymphadenopathy, peritoneal tuberculosis, gastrointestinal (GI) tuberculosis and visceral tuberculosis involving the solid organs.