Cecal obstruction due to primary intestinal tuberculosis: a case series

Abstract

Introduction: Primary intestinal tuberculosis is a rare variant of tuberculosis. The preferred treatment is usually pharmaceutical, but surgery may be required for complicated cases.

Case presentation: We report two cases of primary intestinal tuberculosis where the initial diagnosis was wrong, with colonic cancer suggested in the first case and a Crohn's disease complication in the second. Both of our patients were Caucasians of Greek nationality. In the first case (a 60-year-old man), a right hemicolectomy was performed. In the second case (a 26-year-old man), excision was impossible due to the local conditions and peritoneal implantations. Histopathology revealed an inflammatory mass of tuberculous origin in the first case. In the second, cell culture and polymerase chain reaction tests revealed Mycobacterium tuberculosis. Both patients were given anti-tuberculosis therapy and their post-operative follow-up was uneventful.

Conclusions: Gastrointestinal tuberculosis still appears sporadically and should be considered in the differential diagnosis along with other conditions of the bowel. The use of immunosuppressants and new pharmaceutical agents can change the prevalence of tuberculosis.

Figure 1

Abdominal computed tomography revealing the site of the obstruction.

Figure 2

Double contrast barium enema revealing a stricture in the region of the ileo-cecal valve and ascending colon.

Figure 3

Tubercular mass of the cecum.

Figure 4

Contrast-enhanced abdominal computed tomography showing the cecal mass.

Figure 5

Intra-operative picture showing tubercular adhesions of the omentum and mesenterium, and small intestine enlargement.