Intestinal Tuberculosis Treatment

Intestinal Tuberculosis

The ileocaecal region is commonly involved in tuberculosis because of the following reasons:

• Abundant Peyer’s patches
• Alkaline media
• Bacterial contact time is more
• Minimal digestive activity
• Maximum absorption in the area
• Stasis due to valve—ileocecal valve or Tulp’s valve or Tulpius valve or Bauhin’s valve

Intestinal Tuberculosis Types:

1. Ulcerative variety
2. Hyperplastic variety
3. Mixed (sometimes)

Intestinal Tuberculosis Clinical Features:

• A few features of intestinal tuberculosis such as vague ill health, noisy abdomen, loose stools, evening rise in temperature, and not putting on weight are common.
• Abdominal pain: It is the most common symptom. It can be a dull, vague pain or colicky pain (stricture) which increases after taking food or is relieved by vomiting. Severe colicky abdominal pain vomiting and distension indicate intestinal obstruction.
• Diarrhoea: Watery, small quantity, abnormally foul-smelling. It may alternate with constipation.
• Abdominal distension: It is due to ascites and subacute intestinal obstruction.
• Weight loss is very common. Anorexia, tiredness, and pallor may be the presenting features.

Read And Learn More: General Pathology Notes

Fever with Night Sweats:

• Normal for body temperature to increase at night
• Activation of the immune system
• Decrease in cortisol and adrenaline levels at night
• The attention of the patient

Comparison of two forms of intestinal tuberculosis (TB):

Intestinal Tuberculosis Signs:

• Typically patients are malnourished and pale.
• Visible intestinal peristalsis may be seen.
• Distended bowel loops can be palpated.
• Doughy abdomen in case of peritoneal involvement.
• Rolled-up momentum in the epigastrium, mass in the right iliac fossa due to hyperplastic caecum or in the lumbar region due to pulled-up caecum, loculated ascites as encysted mass surrounded by intestines, and other features.

Intestinal Tuberculosis Investigations:

1. The caseation necrosis in granulomas is the histologic hallmark of TB. In intestinal tuberculosis, the granulomas are multiple, larger (more than 200 µm) and coalescent in mucosa and submucosa—Langhan type of giant cells. CB-NAAT has to be done in all cases to look for rifampicin resistance. A few investigations and pictures are given below.
2. The yield of organisms on smear and culture is low. Staining for acid-fast bacilli is positive in less than 3% of cases. A positive culture is seen in only 20% of cases.

Management of Intestinal Tuberculosis:

1. No evidence of intestinal obstruction: Antituberculous treatment.

2. With obstruction (stricture): More details are given in the chapter on intestinal obstruction.

• Solitary stricture: It is best treated by stricturoplasty by incising the stricture longitudinally and suturing it transversely.
• Multiple strictures at long intervals: Stricturoplasty is the ideal treatment.

• Multiple strictures within a short segment. Resection is the ideal treatment.

3. Surgical treatment of hyperplastic tuberculosis:

Limited resection is the treatment of choice. It includes the removal of terminal 8–10 cm of the diseased ileum, caecum with an appendix, and diseased portion of the ascending colon, followed by ileocolic anastomosis. All these cases have to be given antituberculous treatment for a period of 9–12 months. Nutritional supplementation to improve albumin and haemoglobin levels and, if necessary, blood transfusion before and after surgery helps in smooth recovery in the postoperative period.

Complications of Abdominal Tuberculosis:

1. Intestinal obstruction: Usually it is ileal or jejunal obstruction—details have already been discussed.
2. Perforation: It is not uncommon. Carries 6–8% mortality rate especially in late cases with peritonitis.
3. Malnutrition: Diarrhoea, loose stools, and blind loop syndromes contribute to malnutrition.
4. Faecal fistula is usually due to operated cases of intestinal tuberculosis by resection and anastomosis. In such cases, anastomotic dehiscence may result in faecal The faecal fistula is not due to direct internal involvement of viscera unlike in Crohn’s disease.
5. Disseminated tuberculosis per se from abdominal tuberculosis is not common. Most of such cases have fulminant pulmonary tuberculosis. This happens in untreated cases and immunocompromised cases.