Primary gastric tuberculosis presenting as pyloric outlet obstruction

Abstract

A 38-yr-old Haitian male with a longstanding history of peptic ulcer disease presented with persistent vomiting and weight loss. Barium studies and upper endoscopy revealed gastric outlet obstruction with prepyloric ulcerations. Endoscopic biopsies were consistent with chronic gastritis. The patient did not respond to intensive medical management, including total parenteral nutrition, intravenous cimetidine, and nasogastric suctioning. At the time of surgery, large celiac lymph nodes were noted surrounding the pylorus and the first portion of the duodenum. Biopsies of the wall of the stomach and lymph nodes demonstrated necrotizing granulomas. Cultures for acid-fast bacilli subsequently grew Mycobacterium tuberculosis. A search for foci outside the gastrointestinal tract was negative. Primary gastric tuberculosis remains an extremely uncommon clinical entity; the definitive diagnosis is made by biopsy and positive culture for the organism.