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Intestinal tuberculosis - Causes and pathogenesis
Last reviewed: 04.07.2025
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Intestinal tuberculosis may be an expression of primary (primary intestinal tuberculosis complex), secondary (intracanalicular infection in cavernous pulmonary tuberculosis) or hematogenous extrapulmonary tuberculosis. Primary tuberculosis (often chronic) manifestations predominate, accounting for 70% of cases of abdominal tuberculosis. The route of spread is lymphogenous ("adenogenic").
In primary tuberculosis, intestinal damage is often associated with bovine mycobacteria (Mycobacterium bovis), and in secondary and hematogenous tuberculosis, with human mycobacteria (Mycobacterium tuberculosis) or intermediate (Mycobacterium africanum) species.
Until recently, intestinal tuberculosis was not uncommon. Thus, secondary intestinal tuberculosis, accompanying the terminal stage of pulmonary tuberculosis, has been known since the time of Hippocrates. The appearance of bloody diarrhea in patients with pulmonary tuberculosis was considered a harbinger of an unfavorable outcome of the disease. It can be assumed that intestinal tuberculosis occurs much more often than it is diagnosed, existing under such "masks" as peptic ulcer disease, Crohn's disease, chronic enteritis, etc. It is often an accidental finding during surgery or autopsy.
Morphological manifestations of the lesion are found mainly in the ileocecal section of the intestine. The terminal ileum and the cecum are involved in the process - tuberculous ileotiphlitis. The appendix, ascending, transverse colon and other sections of the intestine are affected less often. Tuberculosis of the rectum can be a manifestation of diffuse tuberculous colitis; secondary lesions of the intestine may develop, resulting in pararectal abscesses and fistulas. Rarely, a specific infectious process passes to the rectum from the uterine appendages or prostate gland affected by tuberculosis.
Depending on the stage and severity of the tuberculosis process in the intestine, various forms can be found: along with specific granulomatosis, ulcerations and stenosis are common due to the proliferation of connective tissue. Therefore, among the complications of tuberculosis, there are both perforations with the development of tuberculous peritonitis (bleeding is rare), and adhesions, strictures leading to intestinal obstruction.