|
|
ORIGINAL CONTRIBUTION |
|
|
|
| Year : 1997 | Volume
: 51
| Issue : 6 | Page : 192-195 |
| |
Tuberculous duodenal obstruction - A case report
S Thakur1, SS Minhas2, A Kanga3, Vijay Sharma3
1 Department of Medicine,
2 Department of Surgery,
3 Department of Microbiology,
Correspondence Address:
S Thakur
Department of Medicine
PMID: 9355724
How to cite this article:
Thakur S, Minhas S S, Kanga A, Sharma V. Tuberculous duodenal obstruction - A case report. Indian J Med Sci 1997;51:192-5 |
Tuberculous involvement of duodenum is regarded as very uncommon presentation of disease. Most cases of tuberculous duodenal obstruction are secondary to extraintestinal lymphnode, involvement. [1] It mimicks other gastrointestinal diseases which is probably why the diagnosis is overlooked. We report here two cases of tuberculous duodonal obstruction due to lymphnode involvement.
CASE 1 : A 24 years female was admitted with loose motions for three months and periumblical pain associated with vomiting for 20 days. Vomiting contained food particles and at times it was bilous. There was family history of tuberculosis. Clinical examination revealed mild anaemia and perabdomen examination revealed firm nodular mass 4.4 cm in the periumbical region. Rest of systemic examination was normal. Investigations revealed Hb 9 gm TLC 8400/Cmm, DLG P 70% L 24% E 3% M3%. Blood urea and serum creatinine were normal. Liver function test, X-Ray chest and plain X-Ray abdomen were normal. FNAG from mass was no,n contributory. Barium meal examination revealed obstruction of third part of duodenum with proximal dilatation of the second part of duodenum and stomach.
The patient was started on antitubercular therapy and conservative management. Hypokalemia was corrected. Exploratory laparotomy revealed multiple caseated lymph nodes in the root of mesentry. One group was obstructing duodenum. Colon was normal. Histopathological examination of lymphnode revealed caseation necrosis with gain cells and lymphocytes. Anterior gastrojejunostomy was done. Post operative course was uneventful.
Case 2: A 36 years male was admitted with pain in epigastrium for 6 months associated with induced vomiting. Two months later the patient complained of vomiting in the evening containing food particles. There was history of intermittent low grade fever for one month. Perabdomen examination revealed fullness in epigastrium with visible peristalsis, however no mass was palpable. The patient was managed as pyloric stenosis. Investigations revealed Hb 11 gm% ESR 20 mm in 1st hour, X-Ray chest, X-Ray abdomen, liver function test, blood urea, serum were normal. Upper G I endoscopy creatinine and serum electrolytes revealed eccentrically placed pyloric opening with marked deformity of first part of duodenum. Barium meal examination showed dilated stomach with extraenous pressure on first part of duodenum. Diagnosis was established on exploratory laprotomy. There was nodal mass in the periduodenal and peripancreatic region 6 cm * 4 cm with periduodenal adhesions. Lymph node mass along with superior mesentric vessels and jejunum showed caseation. Lymph node masses were pressing the first part of duodenum. Rest of intestine was normal. Excision biopsy from lymph node revealed caseation necrosis with chronic inflammatory cells. Posterior antecolic gastrojejunostomy was done and antitubercular therapy was continued.
| ¤ Discussion | |  |
Isolated duodenal tuberculosis sparing other parts of intestine is uncommon. [2] Duodenal tuberculosis is very rare with frequency similar to that of esophageal involvement. [3] The disease may primarily affect duodenum or produce compression due to enlarged mated lymph nodes. The commonest presentation are with obstruction or with non specific dyspeptic symptoms. [4],[5] Third part is the most commonly affected site in the duodenum. The radiological features of duodenal tuberculosis are non specific. [1] Those with features of gastroduodenal obstruction shows duodenum .o be obstructed at various site between bulb and ducdenojejunal flexure. A sharp cut off at the sites of obstruction suggesting extrinsic compression and may mimick superior mesentericrtery syndrome. Duodenurr proximal to obstruction is dilated. Endoscopy with biopsy has not proved to yield good rsulets in the diagnosis of duodenal tuberculosis. [1],[6] Diagnosis is established radiologically regarding site, and pathology of obstruction is confirmed by laprotomy. When resection of part is difficult, a by-pass procedure followed by antitubercular therapy is enough. Both of our patients presented with features of and diagnosis was established at laparotomy and by histopathology.
| ¤ Summary | | |
Proximal duodenal obstruction due to tuberculosis can masquarade as duodenal ulcer. Although commonest cause of duodenal obstruction is ulcer, other causes must be considered, particularly tuberculosis which is common in tropics.[Figure 1], [Figure 2]
| ¤ References | | |
| 1. | Gupta SK, Jain K, Gupta AP et al. Duodenal Tuberculosis. Clin Radio. 1988;39:159-61.  |
| 2. | Reader MM, Philip ESP. Infections and infestations in : Margulis RA, Burhene JH eds. Alimentary tract Radiology. St. Louis: C V Mosby 1989;1478-9. |
| 3. | Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1593; 88:989-99. |
| 4. | Nair KV, Pai CG, Raja Gopal KP et al. Unusual presentations of duodenal tuberculosis. Am. J Gastroenterol. 1991;86:756-60. |
| 5. | Gleason T, Prinz RA, Kirsch EP et al. Tuberculosis of the duodenum. Am J Gastroenterol, 1979;72:36-40. |
| 6. | Tandon RK, Pastakia B. Duodenal tuberculosis as seen by duodenoscopy. Am J gastroenterol. 1976;66: 483-6. |
[Figure 1], [Figure 2]
| This article has been cited by | | 1 |
Duodenal tuberculosis |
|
| Gupta, I., Parihar, A., Dev, G., Gillani, Z. | | JK Science. 2001; 3(3): 132-134 | | [Pubmed] | | | 2 |
Intraluminal duodenal obstruction by a gastric band following erosion |
|
| Taskin M, Zengin K, Unal E | | OBESITY SURGERY. 2001; 11 (1): 90-92 | | [Pubmed] | |
|
|
|
|
