Intestinal tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis.
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Description of the disease
Intestinal tuberculosis leads to the formation of granulomas in its various parts, most often in the ileocecal region.
In recent years, cases of tuberculosis have begun to be reported more frequently.
Usually this disease develops against the background of progression of pulmonary tuberculosis. But there are known cases of the disease developing as a result of infection through food.
A healthy stomach is a good barrier to tuberculosis infection. Therefore, ingestion of a large number of bacteria during pulmonary tuberculosis does not always lead to intestinal damage.
First of all, with intestinal tuberculosis, the lymph nodes of the mesentery are affected, and mesenteric lymphadenitis develops. In the affected areas of the intestine, specific ulcerative tumor-like formations or multiple small red nodules (granulomas) form.
Tuberculous granulomas suppurate and open to form bleeding, confluent ulcers. If they cause intestinal perforation, limited or diffuse peritonitis develops.
Most cases involve the distal small intestine (the end where the small intestine meets the large intestine, on the lower right side of the abdomen) or the cecum.
Less commonly, the process develops in the ascending and transverse colon .
of the rectum and anorectal region is very rare . It is characterized by abscesses and chronic ulcers of the pararectal area. The ulcers do not heal and lead to a narrowing of the rectum. When a tuberculous abscess is opened, a pararectal fistula ( paraproctitis ) is formed.
Symptoms
There are two possible ways to develop intestinal tuberculosis:
- without anatomical lesions (mesenteric lymphadenitis)
- and with them (ulcerative-destructive intestinal lesions).
Symptoms of mesenteric lymphadenitis are as follows:
- pain around the navel, aggravated by walking and physical exertion,
- upon palpation, pain is felt in the left upper and right lower quadrants of the abdomen,
- fever,
- sweating,
- prolonged diarrhea.
All these symptoms do not subside with conventional therapy, and only with the prescription of tuberculostatic drugs does improvement occur.
As the disease progresses and inflammatory processes form in the intestines, severe pain appears in the right lower abdomen, weakness and malaise increase. Upon palpation, you can find a smooth or lumpy, low-painful area there.
Ulcerative-destructive damage to the intestines manifests itself
- symptoms of peritoneal irritation (severe pain and tension when lightly passed over the surface of the abdomen),
- increased fever, and body temperature may differ sharply in the morning and evening,
- blood in stool
- in stool analysis the presence of leukocytes and erythrocytes.
With this course of the disease, complications such as:
- intestinal perforation,
- intestinal bleeding,
- external intestinal fistulas,
- intestinal obstruction.
Characteristic signs of rectal tuberculosis are a false urge to defecate (tenesmus) and the presence of pus and blood in the stool. Pain in the rectum is uncharacteristic and appears mainly when the anorectal area is affected.
Diagnostics
To establish a diagnosis, a comprehensive examination is necessary, which includes:
- general radiography of the chest organs,
- plain radiography of the abdominal cavity,
- irrigoscopy,
- fluoroscopy of the small intestine,
- colonoscopy,
- laparoscopy with biopsy,
- tuberculin tests,
- stool occult blood test.
An ultrasound (ultrasound examination) can detect damage to individual segments of the intestine, enlargement of regional lymph nodes, and ascites (fluid in the abdominal cavity).
Tuberculosis of the anus and rectum is detected during a proctological examination .
Tuberculosis of the intestine is considered established when Mycobacterium tuberculosis is detected in tissue or biological fluids.
Intradermal tuberculin test (the drug is injected subcutaneously into the forearm) and checks the body's immune response. The reaction is checked after 48-72 hours by measuring the transverse diameter of the formed compaction. In patients with tuberculosis it is more than 17 mm. However, the same reaction can occur in other cases, when the immune system is weakened, or upon contact with non-pathogenic environmental mycobacteria.
Differential diagnosis
Differential diagnosis is carried out with
- Crohn's disease,
- ulcerative colitis,
- amoebic dysentery,
- intestinal tumors.
Treatment
Treatment should be carried out in specialized tuberculosis hospitals. One of the most effective treatment regimens for intestinal tuberculosis is daily isoniazid and rifampicin for 9-12 months or isoniazid and ethambutol for 18 months.
These methods give good results, but may have side effects.
Dangerous side effects of taking the drugs include hepatitis, neuritis of the auditory and optic nerves, blood clots and kidney failure.
However, severe side effects occur in 1-5% of patients.
If complications develop, surgical treatment is indicated.
Forecast
The possibility of cure depends on timely diagnosis and treatment. In advanced forms with destructive changes in the small intestine, the prognosis is rather unfavorable. If the colon is affected, the prognosis is less pessimistic, since surgical treatment is possible.
Prevention
A good way to prevent the disease is vaccination. Vaccination (BCG) should be carried out in all people under 20 years of age without prior tuberculin testing.
In people who have household contacts with patients with active tuberculosis, as well as in patients who react positively to tuberculin and are taking drugs that lower immunity, preventive treatment can be carried out.
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