Gastrointestinal tuberculosis

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

  • ileocecal junction (terminal ileum and cecum): most commonly due to the 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 Ileocecal tuberculosis. See related articles for other sites of involvement in the abdomen.

Three types are known:

  • ulcerative 
  • hypertrophic
  • ulcerohypertrophic

Nonspecific and may show

  • cecal wall thickening
  • lymphadenopathy
  • acute to subacute stage
    • narrowing of terminal ileum
    • thickening & gaping of ileocecal valve 
    • thickening & hypermotility of cecum
  • chronic stage
    • ileocecal valve appears fixed, rigid and incompetent
    • cecum appears conical in shape and shrunken in size
    • pulled-up cecum (away from the right iliac fossa) due to fibrotic changes in mesocolon

May show

  • circumferential wall thickening of terminal ileum & cecum
  • 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 cecal involvement
    • less/no ascites
    • vascular engorgement and fibrofatty proliferation of mesentery
  • cecal carcinoma (colorectal carcinoma)
    • eccentric cecal wall thickening
    • evidence of metastatic disease
  • small bowel lymphoma
    • very thick (>2 cm thickness) bowel wall
    • lack of stricturing
    • associated lymphadenopathy +/- hepatosplenomegaly
  • amoebic colitis
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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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