Singh V, Kumar P, Kamal J, Prakash V, Vaiphei K, Singh K
Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India.
Am J Gastroenterol. 1996 Mar;91(3):565-8.
Colonic tuberculosis is common in developing countries. However, its diagnosis is difficult. Nevertheless, colonoscopy and biopsy examination have shown promising results.
We evaluated the clinical spectrum and colonoscopic features of 62 patients with colonic tuberculosis.
Abdominal pain, fever, anorexia, weight loss, and change in bowel habit were seen in more than 50% of the patients. Massive rectal bleeding was frequently (13%) observed. Colonoscopy revealed strictures in 17, deformed ileocecal valve in 34, ulcers in 52, nodules in 49, polypoidal lesions in three, and fibrous bands in five patients. Segmental tuberculosis, lesions mimicking carcinoma, and multiple site involvement were observed in 19%, 20%, and 50% of the patients, respectively. Histopathologically, well formed granulomas were seen in 27, collections of epithelioid cells in 18, and chronic, nonspecific inflammatory changes in 17 of the cases. Acid-fast bacilli could not be isolated from any of the patients. All of the patients responded to the anti-tubercular treatment. Follow-up colonoscopy in 22 patients demonstrated regression of lesions.
Colonic tuberculosis is common in India. Our findings indicate that colonoscopy is useful for its diagnosis. However, histopathology many not always be helpful. Therefore, in a given clinical and colonosopic setting, a therapeutic trial may be indicated.
结肠结核在发展中国家很常见。然而，其诊断困难。尽管如此，结肠镜检查和活检已显示出有希望的结果。
我们评估了62例结肠结核患者的临床谱和结肠镜特征。
超过50%的患者出现腹痛、发热、厌食、体重减轻和排便习惯改变。经常观察到大量直肠出血（13%）。结肠镜检查发现17例有狭窄，34例回盲瓣变形，52例有溃疡，49例有结节，3例有息肉样病变，5例有纤维带。分别有19%、20%和50%的患者观察到节段性结核、类似癌的病变和多部位受累。组织病理学上，27例可见形成良好的肉芽肿，18例可见上皮样细胞聚集，17例可见慢性非特异性炎症改变。所有患者均未分离出抗酸杆菌。所有患者对抗结核治疗均有反应。22例患者的随访结肠镜检查显示病变消退。
结肠结核在印度很常见。我们的研究结果表明结肠镜检查对其诊断有用。然而，组织病理学可能并不总是有帮助。因此，在特定的临床和结肠镜检查情况下，可能需要进行治疗性试验。
