Rathi Pravin, Gambhire Pravir
Prof. and Head of Department.
Senior Resident, Gastroenterology Department, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, Maharashtra.
J Assoc Physicians India. 2016 Feb;64(2):38-47.
Abdomen is involved in 11% of patients with extra-pulmonary tuberculosis; The most common site of involvement is the ileocaecal region, other locations of involvement, in order of descending frequency, are the ascending colon, jejunum, appendix, duodenum, stomach, oesophagus, sigmoid colon, and rectum. Apart from the basic work up, Investigations like CT scan, EUS, Capsule endoscopy, Balloon enteroscopy, Ascitic fluid ADA, TB-PCR, GeneXpert, Laproscopy are being increasingly used to diagnose tuberculosis.Therapy with standard antituberculous drugs is usually highly effective for intestinal TB. Six-months therapy is as effective as nine-months therapy. Multi-Drug Resistance (MDR) has been observed in 13% of MTB isolates. The development of Drug Induced Hepatotoxicity (DIH) during therapy for TB is the most common reason leading to interruption of therapy. There are various guidelines for the management of TB post DIH. Surgery is usually reserved for patients who have developed complications or obstruction not responding to medical management.
11%的肺外结核患者会累及腹部;最常受累的部位是回盲部,其他受累部位按频率递减顺序依次为升结肠、空肠、阑尾、十二指肠、胃、食管、乙状结肠和直肠。除了基本检查外,CT扫描、超声内镜、胶囊内镜、气囊小肠镜、腹水腺苷脱氨酶、结核聚合酶链反应、GeneXpert、腹腔镜检查等检查越来越多地用于诊断结核病。标准抗结核药物治疗通常对肠结核非常有效。六个月的治疗与九个月的治疗效果相同。13%的结核分枝杆菌分离株出现了多药耐药性。抗结核治疗期间发生药物性肝毒性是导致治疗中断的最常见原因。对于药物性肝毒性后结核病的管理有各种指南。手术通常适用于出现并发症或梗阻且药物治疗无效的患者。