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Intestinal Tuberculosis - Diagnosis
Last reviewed: 06.07.2025
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In these cases, X-ray examination of the intestine reveals ulcerations of the mucous membrane, dyskinetic phenomena, cicatricial stenosis, and sometimes filling defects of the cecum. Colonoscopy can clarify the damage to the large intestine. Of additional importance is the examination of feces: reactions to occult blood and the Triboulet test for soluble protein are usually positive; tuberculosis mycobacteria are rarely detected in feces. Blood examination reveals hypochromic anemia, leukopenia with relative lymphocytosis, and during exacerbation - neutrophilic leukocytosis, increased ESR. Tuberculosis tests are usually sharply positive.
Primary intestinal tuberculosis is often diagnosed in the late stages of the disease. Secondary intestinal tuberculosis is easier to diagnose, especially if there is an active specific process in the lungs. It is necessary to take into account the data of clinical, laboratory, bacteriological, endoscopic and radiological examination methods. However, negative bacteriological cultures occur in a significant number of cases of intestinal tuberculosis and, therefore, cannot contribute to its timely diagnosis. It is believed that negative cultures can be a consequence of either long-term antibacterial therapy or damage to the deep layers of the intestinal wall, and not the mucous membrane.
In recent years, ultrasound has been used to diagnose various gastrointestinal tract lesions. Unchanged sections of the gastrointestinal tract are practically invisible during ultrasound. In the case of a pathological process accompanied by thickening of the intestinal or stomach wall, the so-called symptom of an affected hollow organ (AHO) is revealed - an ultrasound image of an oval or round shape with an anechoic periphery and an echogenic center. The peripheral part reflects the pathologically changed intestinal wall, the echogenic center - the contents and folds of the mucous membrane. During the examination, it is possible to obtain a cross-section of the affected area, as well as trace its length.
With careful analysis of clinical data using a set of modern diagnostic methods, it is possible to diagnose gastrointestinal tuberculosis quite reliably. Detection of Mycobacterium tuberculosis and epithelioid granulomas with giant Pirogov-Langhans cells finally confirms the diagnosis. In the absence of these elements in the lesions, characteristic clinical, endoscopic, radiological, ultrasound signs of gastrointestinal tract damage make the diagnosis of intestinal tuberculosis probable and dictate the need for anti-tuberculosis therapy. The combination of the above signs with tuberculosis of other organs should be assessed as gastrointestinal tuberculosis.
Tuberculosis, including intestinal tuberculosis, has its own characteristics in countries with a relatively low economic level. In this regard, the cases of small intestinal tuberculosis we observed in Afghanistan, proven histologically, are of interest.
Differential diagnosis is carried out with nonspecific enterocolitis, Crohn's disease, nonspecific ulcerative colitis, and cancer of the cecum.