Gastrointestinal tuberculosis

Dr Aditya Shetty et al.

Gastrointestinal tuberculosis refers to the infection of abdominal organs with Mycobacterium tuberculosis. It generally affects the following organs:

  • ileocaecum (terminal ileum and caecum): most commonly due to abundance of lymphoid tissue 1
  • colon
  • liver
  • spleen
  • peritoneum
  • lymph nodes

A point worthy of mention is that tuberculosis can affect virtually any organ system directly (primary pulmonary tuberculosis) or indirectly (via spread from primary).

This article deals with Ileocaecal tuberculosis. See related articles for other sites of involvement in the abdomen.

Three types are known:

  • ulcerative 
  • hypertrophic
  • ulcerohypertrophic
Ultrasound

Nonspecific and may show

  • caecal wall thickening
  • lymphadenopathy
Fluoroscopy: barium studies
  • acute to subacute stage
    • narrowing of terminal ileum
    • thickening & gaping of ileocaecal valve 
    • thickening & hypermotility of caecum​
  • chronic stage
    • ileocaecal valve appears fixed, rigid and incompetent
    • caecum appears conical in shape and shrunken in size
    • pulled-up caecum (away from RIF) due to fibrotic changes in mesocolon
CT 

May show

  • circumferential wall thickening of terminal ileum & caecum
  • asymmetric thickening of the ileocecal valve
  • mesenteric lymphadenopathy with central low attenuation areas 
  • involvement of other organs (such as lung)

General imaging differential considerations include

  • Crohn disease
    • more terminal ileal involvement compared with tuberculosis, which has more pronounced caecal involvement
    • less/no ascites
    • vascular engorgement and fibrofatty proliferation of mesentery
  • caecal carcinoma (colorectal carcinoma)
    • eccentric caecal wall thickening
    • evidence of metastatic disease
  • small bowel lymphoma
    • very thick (>2 cm thickness) bowel wall
    • lack of stricturing
    • associated lymphadenopathy +/- hepatosplenomegaly
  • amebiasis: affecting the intestines

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Article Information

rID: 27606
Synonyms or Alternate Spellings:
  • ileocaecal tuberculosis
  • Gastrointestinal TB
  • Gastrointestinal manifestations tuberculosis
  • intestinal TB
  • intestinal tuberculosis

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