Gastrointestinal tuberculosis

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DESPITE the great advances in the management of pulmonary tuberculosis in the last two decades, the disease is not yet a rare problem. It is still necessary to consider this disease in the differential diagnosis for patients whose presenting symptoms cover a wide variety of pulmonary abnormalities. Extrapulmonary tuberculosis is infrequently encountered, but is still an important possibility to consider when evaluating a difficult diagnostic problem. Recently a patient was admitted to the Cleveland Clinic Hospital whose case illustrates the importance of a consideration of tuberculosis that occurs outside the thorax.

Report of a Case

A 56-year-old Caucasian housewife was first examined at the Cleveland Clinic on November 2, 1966, because of symptoms of obstruction of the bowel. In August 1965, incomplete obstruction of the bowel developed; it was treated conservatively. Soon, intermittent pain in the right lower quadrant of the abdomen developed, along with increased frequency of bowel movements, decreased caliber of feces, and fatigue. On a roentgenogram of the chest there was abnormality compatible with old tuberculosis, with minimal residual lesions, but pathologic change never was evident clinically. The gastrointestinal symptoms became progressively worse; and in August 1966, an exploratory laparotomy was performed at another hospital. Numerous nodules of the parietal and visceral peritoneum were reported to be found, and a large intrinsic tumor-like mass affecting the ileocecal region was seen, as well as several other small tumor-like masses in other portions of the ileum. The large mass was biopsied, and an incontinuity surgical bypass was performed. Postoperatively,. . .



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