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Intestinal tuberculosis: diagnosis
Last reviewed: 19.10.2021
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X-ray examination of the intestine in these cases reveals ulceration of the mucous membrane, dyskinetic phenomena, cicatricial stenoses, and sometimes defects in the filling of the cecum. Lesion of the large intestine can be clarified with a colonoscopy. Of additional importance is the study of stool: usually there are positive reactions to latent blood and the Tribula test for soluble protein; Mycobacterium tuberculosis in feces is rarely detected. In the study of blood hypochromic anemia, leukopenia with relative lymphocytosis, with exacerbation - neutrophilic leukocytosis, an increase in ESR. Tuberculosis samples are usually sharply positive.
Primary tuberculosis of the intestine is diagnosed often in the late stages of the disease. Secondary tuberculosis lesions of the intestine can be diagnosed more easily, 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 radiographic methods of investigation. However, negative bacteriological cultures are found in a significant number of cases of intestinal tuberculosis and, therefore, can not contribute to its timely diagnosis. It is believed that negative crops can be the result of either prolonged antibiotic therapy, or - damage to the deep layers of the intestinal wall, rather than the mucous membrane.
In recent years, ultrasound has been used to diagnose various lesions of the gastrointestinal tract. Unchanged parts of the gastrointestinal tract with ultrasound are almost invisible. In the pathological process, accompanied by thickening of the intestinal wall or stomach, a so-called symptom of the affected hollow organ (PCO) is revealed - an ultrasound image of an oval or rounded shape with an anechogenous periphery and an echogenic center. The peripheral part reflects the pathologically altered intestinal wall, the echogenic center - the contents and folds of the mucous membrane. In the study it is possible to obtain a cross section of the affected area, and also to trace its extent.
With a careful analysis of clinical data using a set of modern diagnostic techniques, it is possible to diagnose quite reliably the tuberculosis of the digestive tract. The detection of mycobacteria tuberculosis and epithelioid granulomas with giant Pirogov-Langhans cells finally confirms the diagnosis. In the absence of these elements in the lesions, the characteristic clinical, endoscopic, x-ray, ultrasound signs of lesions of the gastrointestinal tract make the diagnosis of intestinal tuberculosis probable and dictate the need for antituberculous therapy. The combination of the above signs with tuberculosis of other organs should be regarded as gastrointestinal tuberculosis.
Tuberculosis, including intestinal, in countries with a relatively low economic level has its own characteristics. In this regard, the cases of tuberculosis of the small intestine proved by histology in Afghanistan are of interest.
Differential diagnosis is carried out with nonspecific enterocolitis, Crohn's disease, ulcerative colitis, cancer of the cecum.