Tuberculosis of the Duodenum: Clinical presentation, diagnosis and outcome.
Loading...
Date
2013-04
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Buck&round: Duodenal tuberculosis accounts for <2% of abdominal tuberculosis and usually manifests with recurrent
vomiting. Existing guidelines suggest surgery as the mainstay for both obtaining a definitive diagnosis as well as for
therapy.
Aims: The aim of this prospective study was to describe the clinical presentation and usefulness of endoscopic techniques
in the diagnosis and treatment of duodenal tuberculosis.
Methods: Data of patients diagnosed to have duodenal tuberculosis over a three-year-period were analysed for age,
presenting symptoms and outcome of therapy. Diagnosis was based on histological evidence of granulomatous inflammation
along with unequivocal improvement in vomiting and other symptoms over six-eight weeks following a combination of
anti-tubercular drug therapy and endoscopic balloon dilatation.
Results: Ten patients with recurrent vomiting (median age 27 years) were diagnosed to have duodenal tuberculosis.
Significant narrowing was seen at endoscopy in nine patients with post bulbar area being the commonest site in five
patients. Histological diagnosis of granulomatous duodenitis was possible in nine (90%) patients. Balloon dilatation
achieved resumption of normal diet at a median duration of seven days (range 2-40). Symptomatic improvement was
substantiated by a median increase in BMI of 5 kg/m2 over the baseline value. Surgical intervention was not required in any
patient.
Conclusions : Recurrent vomiting due to gastric outlet obstruction is the commonest presentation of duodenal
tuberculosis. Endoscopically, a histological diagnosis of granulomatous inflammation can be achieved in most of the
patients. Endoscopic balloon dilatation coupled with anti-tubercular drug therapy is safe and effective treatment for
this uncommon disease.
Description
Keywords
Tuberculosis, Duodenum, Diagnosis, Outcome
Citation
Puri Amarender S, Sachdeval Sanjeev, Banlml Ameet, Sakhuja Puja. Tuberculosis of the Duodenum: Clinical presentation, diagnosis and outcome. Indian Journal of Tuberculosis. 2013 Apr; 60(2): 83-88.