Jennifer Mercado, Kevin Morton, David Siegel* and Karin Gunther
Department of General Surgery, Ascension Macomb Oakland Hospital, USAFulltext PDF
Background: A 81-year old male with anemia that was found on colonoscopy to have colonic lesions that cultured positive for Mycobacterium tuberculosis complex with non-caseating granulomas on biopsy. Summary: Abdominal tuberculosis is a disease that poses a diagnostic challenge, as the nonspecific features of the disease may lead to diagnostic delays and development of complications. This condition has a vast range of symptomatology that mimics other abdominal pathology (e.g. Crohn’s disease, colon cancer) commonly seen in the developing world. The caseation necrosis in granulomas is the histologic hallmark of TB. We describe an 81-year old male with anemia and constipation that was found on colonoscopy to have colonic lesions both in the medial wall of cecum and in the ascending colon. Colonoscopy findings further included: benign mucosa with hyperplastic glandular pattern, bleeding, edema and non-specific chronic inflammation. Biopsy report of these lesions showed non-caseating granulomas without evidence of malignancy. Patient developed ascites for which he underwent a diagnostic laparoscopy. A substantial amount of ascitic fluid was seen along with peritoneal carcinomatosis and some omental thickening. Peritoneum and omentum specimens on biopsy along with peritoneal washings continued to show non-caseating granulomas with negative acid-fast stain but positive Mycobacterium tuberculosis culture. This case highlights unusual presentations of abdominal tuberculosis with concomitant pathological findings of other commonly seen gastrointestinal disorders further delaying diagnosis and treatment. Conclusion: Abdominal tuberculosis mortality rate has increased due to delay in diagnosis. We present a case of non-caseating granulomatous Mycobacterium tuberculosis presenting as colonic lesions that were initially highly suspicious for malignancy. This case highlights unusual presentations of abdominal tuberculosis with concomitant pathological findings of other commonly seen gastrointestinal disorders that further delaying diagnosis and treatment.
Abdominal tuberculosis; Adenosine deaminase; Omental thickening; Carcinomatosis
Mercado J, Morton K, Siegel D, Gunther K. Non-Caseating Granulomatous Mycobacterium Tuberculosis Presenting as Colonic Lesions: A Case Report. Clin Surg. 2019; 4: 2631.