Severe pulmonary tuberculosis complicating Ileocecal intussusception due to intestinal tuberculosis: a case report
© Nakamura et al; licensee BioMed Central Ltd. 2008
Received: 26 May 2008
Accepted: 13 July 2008
Published: 13 July 2008
Adult intussusception is a rare clinical entity that is most often caused by a tumor, such as a lipoma, adenoma, or malignant tumor. A case of adult intussusception due to intestinal tuberculosis of the ileocecal region is reported. There are few cases of intussusception due to intestinal tuberculosis.
Intestinal tuberculosis continues to be a major problem in many regions of the world. In the abdomen, tuberculosis may affect the intestinal tract, lymph nodes, and peritoneum. The lack of specific signs and symptoms of abdominal tuberculosis involving the intestinal tract frequently leads to missed or delayed diagnoses, which can result in severe complications that are associated with intestinal tuberculosis, including obstruction, perforation, and fistula formation , though intussusception is uncommon. The case of a 76-year-old female who developed intussusception due to intestinal tuberculosis is reported. Adult intussusception is rare, and few cases caused by intestinal tuberculosis have been reported. Generally, a surgical procedure is needed for adult intussusception, and the outcome is often poor [2, 3]. Early and proper diagnosis of intestinal tuberculosis is necessary to prevent severe complications.
Intussusception occurs when a proximal segment of bowel and its associated mesentery telescope into the lumen of the adjacent distal segment. It is a rare entity in adults; it accounts for only 1% of all cases of intestinal obstruction and 5% of all intussusceptions [4, 5]. Intussusceptions involving the small intestine are, in about 90% of cases, the result of benign processes, including polyps, such as lipomas, adenomas, and inflammatory polyps, Meckel's diverticulum, and adhesions [6–8]. On the other hand, in the large intestine, malignant processes, usually adenocarcinomas, are common causes of intussusception . Abdominal tuberculosis is still a major problem in many regions of the world. In particular, the incidence of intestinal tuberculosis has been increasing in the West, due to the AIDS epidemic, transglobal migration, an aging population, and an increasing number of immunosuppressed patients [10, 11]. The abdominal complications of intestinal tuberculosis include perforation, fistula formation, and intestinal bleeding . Obstruction is the most common complication, and it occurs in 12–60% of cases . Intussusception is a very rare complication. In the present case, the inflammatory lesions formed by the advanced intestinal tuberculosis likely caused the intussusception. Intestinal tuberculosis is not commonly diagnosed early because the symptoms are often non-specific. It has been reported that abdominal CT findings can help in making the diagnosis of intestinal tuberculosis . When the inflammatory process is mild, CT shows only slight and symmetric wall thickening and a few small regional lymph nodes, while in the advanced stage, CT shows asymmetric thickening of the ileocecal valve and medial wall of the cecum, and a heterogeneous soft-tissue mass that envelopes the terminal ileum. The location of the disease is also helpful in making the diagnosis of intestinal tuberculosis. Approximately 75% of intestinal tuberculosis patients have involvement of the distal small bowel and ileocecal region . In addition, abdominal CT has been reported to be the most useful tool for diagnosis of adult intussusception, with a diagnostic accuracy rate of 58–100% [14, 15]. In the present case, the patient likely had intestinal tuberculosis for a long time, and it was found because of the development of the intussusception. Furthermore, some authors have reported that patients with diseases causing immunosuppression are more likely to have severe intestinal tuberculosis [16, 17]. Thus, the present patient probably developed intestinal tuberculosis due to her immunosuppressed status as a result of severe undernutrition and advanced age.
Intussusception is rare in the adult population, and, to the best of our knowledge, intussusception caused by intestinal tuberculosis is very rare. Early detection of intestinal tuberculosis is important to avoid catastrophic events, including intussusception, since emergency surgery for such lesions carries a high mortality rate. Abdominal CT appears to be helpful in making an early diagnosis and preventing the severe complications of intestinal tuberculosis.
We did informed consent for the patient about publishing the manuscript to Annals of Clinical Microbiology and Antimicrobials. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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