Intestinal tuberculosis in a regional hospital
in Hong Kong: a 10-year experience
VKS Leung, ST Law, CW Lam,
ISC Luk, TN Chau, TKL Loke, WH Chan, SH Lam
Department of Medicine and Geriatrics, United Christian Hospital,
Kwun Tong, Hong Kong
OBJECTIVE. To study the clinical and pathological characteristics of patients with intestinal tuberculosis.
DESIGN. Retrospective study.
SETTING. United Christian Hospital, Hong Kong.
PATIENTS. Patients with intestinal tuberculosis diagnosed between January 1995 and December 2004 inclusive.
RESULTS. The median age of the 13 male and 9 female patients was 53 years (range, 12-81 years). Nineteen (86%) had a definitive diagnosis of intestinal tuberculosis confirmed by the presence of caseating granulomas and/or acid-fast bacilli in histological specimens. In three (14%) the diagnosis was based on histology revealing non-caseating granulomas and a positive response to anti-tuberculous treatment. Common symptoms included abdominal pain (82%), diarrhoea (55%), weight loss (55%), and fever (45%). Three (14%) of the patients were complicated by intestinal obstruction, and another two (9%) had intestinal perforation. Four (18%) had concomitant active pulmonary tuberculosis. The most frequently involved site was the ileocaecal region, which was affected in 19 (86%) patients. Other sites included the jejunum, ascending and sigmoid colon. The diagnosis of intestinal tuberculosis was facilitated by examination of colonoscopic biopsy specimens (11 patients), and by examination of resected surgical specimens in the remainder. Two patients died from terminal malignancy. The remainder completed anti-tuberculous therapy and responded satisfactorily.
CONCLUSIONS. The diagnosis of intestinal tuberculosis is difficult due to the lack of specific signs or symptoms. Colonoscopy with ileoscopy are useful tools in the search for colonic and terminal ileal tuberculosis. Surgical exploration is reserved for equivocal cases and for those who present as emergencies.
Hong Kong Med J 2006;12:264-71
Key words: Cecum; Colonoscopy; Granuloma; Ileum;