Tuberculosis has become a resurgent global problem with increasing numbers of immunocompromised patients, largely related to the global acquired immunodeficiency syndrome pandemic. The chief method of diagnosis is roentgenological and its development has been due chiefly. Though ileocaecal region accounts for 75% of the gi tuberculosis, primary involvement of appendix is very rare and accounts for only 0. Incidence of primary tuberculous appendicitis is 0. Ruptured appendix in tuberculous abdomen longdom publishing. Abdominal tuberculosis of the gastrointestinal tract. Tuberculous appendicitis the american journal of medicine. Autopsy figures among patients of tuberculosis also reveal appendicular. Intestinal tuberculosis is a rare condition and its diagnosis remains a challenge to the physician. Treatments included appendectomy and first category of anti tuberculosis drugs atd for 6 months. The commonest mode of acute presentation in this series was intestinal obstruction 47% followed by perforative peritonitis 31%, acute appendicitis 10% and others 12% tablefig1. The incidence among patients with known tuberculosis ranges from 1. Double localization of tuberculosis is a rare finding among immunocompetent patients. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity.
Further imaging was accomplished with computed tomography ct of the abdomen and pelvis with intravenous and oral contrast. Acute tuberculous appendicitis with intestinal obstruction. This revealed acute appendicitis in the right lower quadrant congruent with earlier physical examination. Though an ileocecal region is the most frequent site of involvement of the intestinal tuberculosis, vermiform appendix involvement is rare. Autopsies of patients with pulmonary tb before the era of effective treatment demonstrated intestinal involvement in 5590% of fatal cases. Primary tuberculosis of appendix is extremely rare. Pulmonary tuberculosis tb was highly suspected, and the patient was placed in an isolation room. Moreover, intestinal tuberculosis is an uncommon cause of lower gastrointestinal hemorrhage. Despite gastrointestinal tuberculosis being common in india, affliction of the appendix with the disease remains a rarity. After surgery, the patient started antitb treatment on the fourth postoperative day and continued. Tuberculous enteritis presenting as acute appendicitis and.
Abdominal tuberculosis rates are rising, consistent with the overall trend. Therefore, bleeding from tuberculous appendicitis is a very rare presentation. Gastrointestinal tuberculosis tb accounts for 3% of extrapulmonary tb. Tuberculosis tb is a common disease that ranks as the second. This revealed acute appendicitis in the right lower quadrant congruent with earlier physical examination findings figure 2. The prevalence of appendicitis in teenagers and young adults suggests a pathophysiologic role for lymphoid aggregates that exist in abundance in the appendix of this age group 5,9,14. A high index of suspicion is essential for reaching its diagnosis. Back to journals international medical case reports journal volume 11. Involvement of the appendix is rare, occurring only in about 1% of cases. Clinical and radiological findings of abdominal tuberculosis are nonspecific.
Intestinal tuberculosis a recent series which highlights the intestinal tubeculosis provides a elaborate view of symptomatology of the colonic tuberculosis table 2. Diagnosis and treatment of acute appendicitis jmaj 465. The reported incidence of appendicular tuberculosis in all appendectomies performed varies from 0. Diagnosis was established based on histopathological findings. Intestinal tuberculosis is caused by mycobacterium tuberculosis, as in any other organ involvement, tuberculosis symptoms remain same except intestinal involvement may produce chronic pain in the abdomen, diarrhea, or. Primary intestinal tuberculosis accounts for only 10% of the cases, resulting from ingesting infected milk 2. The clinical features of this disease are nonspecific and can be very similar to crohns disease. However, primary tb of the appendix is rare and may or may not be. Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. Pdf tubercular appendicitis a case report researchgate.
Tubercular appendicitis a case report world journal of. This revealed acute appendicitis in the right lower quadrant. The spread of the disease is further aided by poverty, overcrowding, and drug resistance. Tuberculous appendicitis is a rare type of abdominal tb and is seen in only 0. A rare occurrence is gastrointestinal tuberculosis. Laboratory findings are usually of little aid in diagnosis. It is a great mimicker that has unusual presentations. Intestinal tuberculosis symptoms, diagnosis and treatment. We reported an acute tuberculous appendicitis with intestinal obstruction.
Background gastrointestinal tuberculosis tb accounts for 3% of extrapulmonary tb. Intestinal tuberculosis is a common clinical problem in india. Any portion of the gastrointestinal tract git can be involved with tuberculosis, the most. Primary tuberculous appendicitis presented with caecal.
Indian journal of pediatrics, volume 72 august, 2005. Rijal, abdominal tuberculosis, journal of nepal medical association, vol. An uncommon case of chronic tubercular appendicitis hindawi. The diagnosis of appendicitis by ct depends on hypertrophy of the appendiceal wall, enlargement of. Diagnosis of intestinal tuberculosis diseases of the chest. The ulcerative lesion is the most common of the three varieties and its diagnosis can be made with a high degree of accuracy. The previously noted frequent association between pulmonary tb and intestinal tb no longer prevails, and only a minority of patients abstract tuberculosis of the appendix remains a rarity despite the frequency of intestinal tuberculosis. Indian journal of pediatrics, volume 72august, 2005. Case report tuberculous appendicitis presenting with lower. We report a case of acute appendicitis that underwent appendectomy at our hospital, and the histopathology of the specimen revealed tuberculosis. Gastrointestinal tuberculosis is quite rare, representing only 3% of all extrapulmonary cases. Eight per cent of 1,801 consecutive patients at the trudeau sanatorium had definite intestinal tuberculosis. We present the case of a 21 year old male patient with intestinal tuberculosis in which the first manifestation was an acute appendicitis.
According to this theory, obstruction leads to inflammation, rising. Gastrointestinal tuberculosis tb is a relatively rare form of extrapulmonary tb in the us and is estimated to occur in only 1. Intestinal tuberculosis occurs as an ulcerative lesion complicating pulmonary tuberculosis, as a hypertrophic mass, and as a miliary form associated with tuberculous peritonitis. Intestinal tuberculosis is the most frequent complication of pulmonary tuberculosis and is found in from 50 to 80 per cent or even more of all autopsies performed on patients who have died from pulmonary tuberculosis. Ulcerative intestinal tuberculosis is always a complication of pulmonary tuberculosis and often shows an activity parallel to that of the parent lesion. Pdf tuberculosis of the appendix remains a rarity despite the frequency of intestinal. A 40year old male presented with chronic abdominal pain for 2 weeks. Appendicular tb presenting the signs and symptoms of acute appendicitis is an even rarer occurrence.