Gastrointestinal (GI) tuberculosis (TB) is rare and can occur in the context of active pulmonary disease or as a primary infection with no pulmonary symptoms. It typically presents with vague abdominal symptoms, making it difficult to discern from alternative disease processes. Although the ileocecal region is the most commonly affected site, tuberculous enteritis can involve any aspect of the GI tract. To demonstrate the importance of maintaining a high clinical suspicion for the disease, we present a case of GI TB presenting as severe malnutrition and segmental colitis of the left colon.

Essentials of Diagnosis:-


• Fever, anorexia, nausea, flatulence, food intolerance and distension after food.
• Chronic abdominal pain varying from mild to severe cramps.
• Mild to severe diarrhoea.
• Doughy feelings of abdomen on palpation.
• X-ray findings according to type of lesion, i.e. irrita-
bility and spasm particularly in caecal region, irre- gular hypermotility of the intestinal tract, irregular filing defects (hypertrophic type of lesion) are noted. Persistent narrow beam of barium in small bowel (string sign) is seen. Biopsy and animal innoculation are confirmatory. The presence of tubercle bacilli in stool does not correlate with intestinal involvement.

Treatment:-

-Pyrazinamide. < 50 kg– 1.5 gm
50-75 kg- 2gm

>75 kg-2.5 gm

-INH 300 mg od
-Rifampicin 450 mg/day if body weight is 55 kg.
Above 55 kg body weight 600 mg daily should be given in a single dose before breakfast.
It may be given in single dose or in 2 divided doses.
-Ethambutol 25 mg/kg body weight as single dose.
-Supplementary multivitamins and Pyridoxin 40 mg daily .


Surgical Treatment:-

  1. Localised hypertrophic lesion.
  2. Stenosis of bowel.
  3. Perforation of tuberculous ulcer.

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