Tuberculosis of the abdomen
It commonly affect the ileocecal area (LQ 2012) in 70% of the cases. The other area involved are ascending colon, jejunum, appendix, sigmoid colon, rectum, duodenum, stomach and esophagus(in descending order of frequency).
- Ulcerative (60%)-
- Hypertrophic (10%)-
- Common in ileocecal region.
- Scarring, fibrosis, mass lesion mimicking carcinoma
- Ascitic type-
- Lymphatic spread from an intestinal focus lead to peritoneal involvement
- The fibroblastic bands and adhesions may obstruct bowel loops and produce features of subacute intestinal obstruction.
- Lympho glandular type-
- The predominant involvement is of mesenteric lymph nodes
- Chronic pain abdomen is the most common presenting symptom (80-90%)
- Blood in the stools.
- Fistula formation
- Plain X-ray-
- Calcified lymph nodes
- Multiple air fluid levels
- Dilated bowel loops
- Barium meal/enema-
- Sterling sign- Failure of diseased segment to retain barium which is adequately retained by adjacent normal segment.
- String sign-thin segment of barium resembling a string in the terminal ileum.
- Ascitic fluid examination-exudative with lymphocytic predominance. Punch biopsy of the ascitic fluid reveals tubercular lesion.
- CT abdomen
- ATT for 6 months.
- Surgery if obstructive features are there.
Extra Edge Sterling and String sign are also seen in Crohnβs disease.
CausesPrimary β idiopathic, autosomal dominant, (due to myopathy or ANP)Secondary β Scleroderma, SLE, DM, Hypothyroid, Parkinson, Phenothiazine, TCA