Which of the following is not true regarding hyperplastic tuberculosis: March 2005
Ans. D: Should be managed by surgical resection of the involved segment On gross pathologic examination, intestinal TB can be classified into 3 categories: The ulcerative form of TB is seen in approximately 60% of patients. Multiple superficial ulcers are largely confined to the epithelial surface. This is considered a highly active form of the disease, with the long axis of the ulcers perpendicular to the long axis of the bowel. The hyperophic form is seen in approximately 10% of patients and consists of thickening of the bowel wall with scarring; fibrosis; and a rigid, mass like appearance that mimics that of a carcinoma. The ulcero-hyperophic form is a subtype seen in 30% of patients. These patients have a combination of features of the ulcerative and hyperophic forms. The ileum is more commonly involved than the jejunum. Ileocecal involvement is seen in 80-90% of patients with GI TB. This feature is attributed to the abundance of lymphoid tissue (Peyer patches) in the distal and terminal ileum. Clinical features of intestinal TB include abdominal pain, weight loss, anemia, and fever with night sweats. Patients may present with symptoms of obstruction, right iliac fossa pain, or a palpable mass in the right iliac fossa. Hemorrhage and perforation are recognized complications of intestinal TB, although free perforation is less frequent than in Crohn disease. Early changes on barium examinations reveal nodular thickening of mucosal folds, with loss of symmetry in the fold pattern. As with Crohn disease, deep fissures, sinus tracts, enterocutaneous fistulae, and perforation can occur, although less commonly. A cobblestone appearance of the mucosa is a feature seen in Crohn disease that is not seen in TB. Ulceration may be demonstrated on double-contrast examinations, typically perpendicular to the long axis of the bowel; these heal with the formation of sho annular strictures. Because of persistent irritability from inflammation in the terminal ileum, rapid emptying of that segment may occur (Stierlin sign). The ileocecal angle is obliterated with a widely patent ileocecal valve The most common site of GI TB is the ileocecal region, if the area can be reached with a flexible endoscope. A rapid diagnosis can be achieved if smear or culture results are positive or if caseating granulomas are seen in biopsy samples. In countries where GI TB is endemic, a therapeutic trial of antituberculosis treatment may be justified if the clinical picture is compatible with TB.
Mass in right iliac fossa may be the presenting feature
Barium studies are helpful in diagnosis
Ileo-caecal junction is common site of involvement
Should be managed by surgical resection of the involved segment