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Abdominal tuberculosis accounts for 3 to 5% of all visceral diseases. Despite the demonstrated effectiveness of anti-tuberculosis treatments, some cases of exacerbation of the initial clinical presentation have been described during the initiation of treatment. However, these reactions also known as "paradoxical" have been rarely reported in immunocompetent patients and much less in the case of bowel obstruction. We report a case of intestinal tuberculosis revealed by acute bowel obstruction during paradoxical reaction to anti-tuberculosis treatment. The study included a 26-year old immunocompetent patient with occlusive syndrome after a month of treatment for pleuropulmonary tuberculosis. Abdominal computed tomography (CT) showed small bowel obstruction. Laparotomy objectified intraperitoneal mass with multiple adhesions. Anatomo-pathological examination of the surgical specimen showed intestinal tuberculosis. Patient's outcome was favorable after the continuation of initial antituberculosis treatment., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Gastrointestinal tuberculosis represents 1% of extrapulmonary tuberculoses and only sporadic cases of anal tuberculosis have been reported in the literature. We report two cases of tuberculous anal abscess and a review of the literature for diagnosis and treatment.

The incidence of abdominal tuberculosis has increased over the last decade and can mimic any other disease. Pancreatic involvement is an uncommon cause of jaundice in children. A case of obstructive jaundice due to pancreatic tuberculosis in an infant, with hepatic involvement is reported. The sonographic and computed-tomographic features are described.

Introduction: We report the case of a patient with abdominal tuberculosis initially treated as Crohn disease., Case: A 50-year-old man, diagnosed with Crohn disease, was admitted to the intensive care unit for acute respiratory failure. After a new diagnosis of pulmonary and ileocecal tuberculosis and appropriate treatment for it, he improved., Discussion: It is difficult - but essential - to differentiate intestinal tuberculosis and Crohn disease, for the immune suppression necessary to treat the latter can induce severe complications of the former. Management of intestinal tuberculosis is primarily medical, with surgery reserved for complications such as obstruction, fistulization, perforation, and bleeding.

Isolated pancreatic tuberculosis is rare, and can mimic pancreatic carcinoma. We report a case of pseudoneoplastic pancreatic tuberculosis revealed by an obstructive jaundice in a 35-Year-old man. Surgical pancreatic histopathology showed a caseating granulomatous inflammation and diagnosis was confirmed by detection of Mycobacterium tuberculosis DNA using specific polymerase chain reaction-based assay (PCR). The patient was successfully treated with quadruple antituberculous therapy. In the context of the diagnostic work-up of a hypodense pancreatic mass, the diagnosis of tuberculosis relies on the presence of pancreatic caseating granulomas, that can be obtained by endosonography-guided biopsy, thus avoiding laparotomy.

We report two cases of pancreatic tuberculosis. The first patient had abdominal pain, jaundice and weight loss. Ultrasonography and CT scan suggested a pancreatic tumor. The second patient presented with abdominal pain without jaundice while CT scan showed a pancreatic mass. Diagnosis of pancreatic tuberculosis was made at laparotomy in the two cases. The two patients underwent hepatico-jejunostomy. The first one received antituberculous chemotherapy and completely recovered while the second died because of post-operative shock related to sepsis. Tuberculosis must be suspected in the presence of a pancreatic mass in endemic countries or in immunocompromised patients. Needle biopsy may in some cases lead to diagnosis and avoid laparotomy.

A good digital examination is usually sufficient for the diagnosis and the treatment planning of anal fistulae. Cross-sectional imaging techniques, however, can accurately identify deep abscesses and characterize complex fistulae. MRI is well suited for this examination, with almost no motion artifact, excellent contrast between muscles and fatty spaces, and multiplanar acquisition. A fistula starts from an internal opening in the digestive tube and can end in an abscess cavity or open at the skin at an external opening. The cryptoglandular anal fistulae (fistula-in-ano) are non-specific in origin and are usually simple, whereas specific fistulae are due to many diseases such as Crohn's disease, tuberculosis, trauma, radiation, colloid carcinoma, hidradenitis suppurative, actinomycosis or lymphoma and are often complex. MRI appears useful in the cases with recurrent fistulae, Crohn's disease, when the secondary orifice is atypically placed, during a multistep treatment for complex fistulae, or when an anal stenosis forbids a clinical or ultrasound examination. A good knowledge of the perineum anatomy is required for analysing the fistula tracts. The muscle planes separate fatty spaces which have an important role in the spread of the disease: sub-mucosal space, marginal space, intersphincteric space, postanal space of Courtney, supralevator space, and the two ischioanal spaces on both sides of the anal canal. The anal canal is surrounded by the ring-like internal sphincter, which continues the internal muscularis propria of the rectum, and the external sphincter, which is intermingled with the puborectalis muscle. We perform our MRI examination with an external phased array coil, and we place a cannula to identify the anal canal. The T2W sequences give the more interesting information, but the sequences with fat-suppression and gadolinium chelate injection are also very useful. The MRI examination allows the analysis of: 1) the location of the fistula tracts according to Park's classification, 2) the location of the internal opening, 3) the locations of the external opening(s), 4) the location of deep abscesses, 5) the long distance extensions, 6) the state of the ano-rectal wall and the perirectal spaces, 6) the damages of the anal sphincter.

Colonic tuberculosis rarely causes massive bleeding, as a matter of fact less than twenty cases have been reported in medical literature. Resorting to surgery in this context is even more exceptional. We have not found any case operated on in the literature we have consulted. Endoscopy together with histological study of biopsies is the best exam for the diagnosis of this disease. We report the case of a 37 year old male, coronarian, carrying a caecal lesion evocative of tuberculosis at the endoscopic exam, who had an emergency right hemicolectomy for massive bleeding caused by caecal tuberculosis. The surgical indication was dictated by the abundance and the persistence of the bleeding. The post-operative course was uneventful.

The authors report a case of ileocaecal tuberculosis in a 27-year-old man with no particular risk factor for this disease. The initial diagnosis was terminal ileitis discovered at appendicectomy. The diagnosis of ileal tuberculosis was suspected in the presence of giant cell follicles on ileal biopsies, and was confirmed by the presence of AFB in the gastric intubation fluid. This patient presented known atypical pulmonary images for several years, which had never been investigated in more detail. A favourable course was observed in response to triple-agent, then double-agent antibiotic therapy. This case illustrates the fact that ileal tuberculosis still exists today, and that it does not exclusively affect "high-risk" patients.

It's the case of a Senegalese man who presents a chronic rebel diarrhea with alteration of the general condition and a malabsorption. The aetiologic management has been very difficult to achieve after we have eliminated the infectious and parasitological causes. The clinical and epidemiological context with the histopathological arguments allowed us to establish the diagnosis of intestinal tuberculosis.

Tuberculosis of the duodenum was revealed in two patients by severe upper digestive tract bleeding. These cases illustrate the difficulties in diagnosing tuberculosis of the duodenum which can present as a simple bleeding ulceration. This "infectious" ulcer is an exceptional finding but certain diagnosis can be made at laparotomy with extemporaneous pathology of the lymph nodes. For non-complicated cases, the diagnosis may be suspected on the bases of routine laboratory tests. Surgery should be limited as much as possible since specific antibiotics are usually successful in cases of digestive tract tuberculosis.

An overview of a series of patients treated for peritonitis over the last 5 years showed that in 64 cases (6.8%) the infection was due to a non traumatic perforation of small intestine. The predominant aetiology was typhoid fever (39 cases), other causes for the peritonitis were perforation of an abdominal diastasis (10 cases) or a Meckel's diverticulum (8 cases), and perforation due to an acute ileitis (2 cases), a non Hodgkins malignant lymphoma (2 cases), a necrotizing enteritis (2 cases) and a jejunal tuberculoma (1 case). The surgical attitude to be adopted for repair of the perforated loop is dependent on the aetiology and the degree of peritoneal sepsis. Enterostomy should be performed as a safety measure in patients with perforation due to typhoid fever.

The authors relate the case of a duodenal tuberculosis shown by a pyloro-duodenal stenosis. They emphasize the absence of specific clinical, radiological endoscopic and histological manifestations. Laparotomy is in most cases necessary. The diagnosis is therefore affirmed out of the findings of peritoneal granulations or the extemporaneous anatomo-pathological investigation of lymphatic nodules.

This work is a report about 8 cases of enterolithiasis treated in our University Hospital between 1980 and 1990. We emphasize the rarity of this condition. We also note its relative frequency (5 of 8 cases) in the Bedouin population of our mostly desertic area, and question the possible impact of a diet rich in goat's milk and/or of tuberculosis, which is still endemic in some tribes. We then discuss the difficulties of diagnosis and the essential contribution of small bowel radiographs. The etiologies of enterolithiasis are reviewed, as well as the various modalities of treatment.

We report 2 cases of intestinal perforation caused by tuberculosis and affecting the small intestine in one case and the colon in the other case. The patients were men aged 49 and 51 years respectively. Both were cachectic and presented with advanced open pulmonary tuberculosis. Perforation in free peritoneal cavity occurred 2 and 8 days respectively after an antituberculous treatment was initiated. The outcome was rapidly fatal in both cases. Tuberculous enteritis has become rare, but it can still be observed in patients with severe open pulmonary tuberculosis, where the gastro-intestinal tract is contaminated by the large number of virulent mycobacteria swallowed. In such patients clinicians must be alert to abdominal premonitory signs. Intestinal perforations in free peritoneal cavity are uncommon. Most perforation are small, single or multiple, and located on the antimesenteric side of the terminal ileum. They may occur at any time, and particularly just after an antituberculous therapy has been instituted. Clinical presentation is one of acute peritonitis requiring emergency laparotomy. Mortality has been reduced by technical improvements, notably temporary enterostomy, but perforation remains a serious and often fatal complication of tuberculosis in patients with severe malnutrition.

The authors report a case of duodenum tuberculosis associated to a lymph gland tuberculosis. Diagnosis has been made possible only with an exploratory laparotomy justified by an almost total duodenum stenosis. They review the different aspects (pathogenic, anatomopathologic, clinical, radiological, therapeutic) of a disease non frequent but not exceptional, especially in the african countries.

Colonic tuberculosis is currently exceptionally rare in western countries. This interesting report reminds of its existence and emphasizes the diagnostic problems with Crohn's disease in the past. The barium enema enables to show the main aspects of colonic tuberculosis, i.e. variable forms of stenosis. The contribution of colonoscopy is essential in defining the lesions and allowing multiple biopsies. These biopsies may show the presence of granulomas with caseous necrosis, and possibly the Koch Bacillus on direct examination or in culture. The conditions of prescription of the medical treatment are similar to that of other tuberculous locations. Surgery is indicated in the presence of complications, when there is a doubt the malignant nature of the lesion, finally at the stage of cicatricial stenosis.

Two cases of peri-anal ulceration of tuberculous origin are reported: one revealed an active pulmonary and ileo-caecal tuberculosis, the other complicated a chronic pulmonary tuberculosis of several years' duration. Cutaneous manifestations of tuberculosis are exceptional. In patients with protracted peri-anal ulceration, a biopsy should be performed that will show a typical tuberculoid granuloma. The most frequently encountered anorectal tuberculous lesions are suppurations and fistulae. The main differential diagnosis is Crohn's disease with anorectal manifestations.

The authors report on a case of anorectal tuberculosis. Revealed by an hemorroïdal thrombosis with febrile symptoma and purulent discharge, its macroscopic aspect was the one of anal mucous membrane ulceration, irregular with elevated border. The diagnosis was confirmed by anatomopathologic exam. The course was favourable under specific treatment. Etiologic investigation did not show any other localisation. Then, present aspects of anorectal tuberculosis are discussed, as well as possible relationships with hemorroïdal disease and its complications, particularly the fissural ones.

A case of gastric tuberculosis associated with villous atrophy is reported in a sixty-three years old female. Fifteen years before she had a skin-disease whose histology was compatible with a dermatitis herpetiformis. Under treatment by gluten exclusion and anti-tuberculous drugs, a cure of gastric tuberculosis and a dramatic relapse of jejunal morphology were observed.

The authors report seven cases of tuberculoid granulomatous gastritis. Tuberculosis was the cause in three cases. Bilharziasis was the cause in two cases. Sarcoidosis was identified in one patient. In only one case was the etiology undetermined. This seems rare. Some of these form should be compared with experimental tuberculoid granulomatous gastritis, obtained after sensitisation to foreign substances included in the gastric mucosa. The organisation of the epithelioid and giant cell granuloma corresponds to an immune defence reaction of the stomach, bringing into play immunoglobulins IgG and IgM to lead to the formation of antigen antibody complexes in these tissues.

The perforation into free peritoneum is a singular complication of the intestinal tuberculosis. Regarding a recent observation of this complication revealing small intestinal tuberculosis, we have tried to make the point on this exceptional form of small intestinal tuberculosis. By means of prolonged enteric nutrition and antitubercular treatment, the patient will be cured of this disease without any after-effects as we mentioned it in our observation. Very fearsome in the past (44 deaths out of 104 published cases), perforation into free peritoneum nowadays has a better prognosis.

In most cases the ano-cutaneous clinical symptoms correlated to diseases of the gastro-intestinal tract are not specific (erythema, itching, wounds or scarring). However in the following diseases occasional dermatological lesions may directly contribute to their diagnosis: in Crohn's disease, tuberculosis of bowel, chronic entamoebiasis and bilharziosis, the skin lesions of the anal area have the same histological structure as the gut lesions. Perianal fistulas and ulcers are frequent in Crohn's disease especially if there is a colonic and rectal spreading; they respond badly to steroid therapy and are often correlated with a worse prognosis. Perianal specific lesions occur often in oxyuriasis in children, in candidiasis of the digestive tract, in systemic aphthosis and in some malignancies. In other gastro-intestinal disturbances, the dermatological and features are less specific and can only be suggestive: iatrogenic and microbial diarrheas, side-effects of laxatives, proctological diseases. It has to be emphasized that pruritus ani is only induced by deeper lesions when they spread to the perianal skin. In proctological practice, contact dermatitis by sensitivity to anaesthetics or suppository balsams (Peruvian balsam), itching or burning atrophy by topical steroid abuse, non-diagnosed fungal (candidiasis), bacterial (erythrasma) or psoriatic intertrigos (flexural psoriasis) may sometimes explain the failure of therapy.

Report of an african case of idiopathic mega-oesophagus observed after 6 years of evolution without any treatment. Surgery (Heller technic) gave a good result and brought evidence of a non-expected peritoneal tuberculosis related to cachexy. The patient having discarded all medical follow-up, death occured 2 years later.

The authors analyse a series of 30 cases of generalised fecal peritonitis which represents a less frequent form of peritoneal infection. The etiology was mainly diverticular perforation (50 p. cent) or neoplasia (25 p. cent). The mortality was high (63 p. cent). It seems, in the light of the results, that the best treatment consists of operating in two stages, the first being the eradication of the colonic lesion which should be carried out as a routine without attempting immediate anastomosis. Wide drainage with peritoneal lavage and the use of "noxythioline" may improve the results of a disease which always remains very severe.

Fibrosis of the intestinal lymphatic vessels, produced in one case by tuberculosis and, in the other, by appendicitis and peritonitis, caused blockage of the main lymphatic vessels causing, clinically, a protein-losing enteropathy similar to that noted in congenital lymphatic diseases of childhood. In the laboratory, there was noted a fall in serum protein, lipid and cholesterol. A fat absorption test was very abnormal showing a flat curve. During laparotomy, there was discovered on the small intestine, the same layout of lymph vessels, resembling a lace network, as that observed in congenital malformations. Intestinal lymphography showed considerable stasis of the opaque substance and absence of injection of the lymph vessels in the mesentery.