Intestinal tuberculosis
The intestinal tuberculosis - caused by mycobacteria - the most common specific worldwide inflammation of the intestine . In Germany, however, the disease has become very rare.
The end of the ileum (the lower ileum) and cecum (the cecum) are the most common sites, but each section of the can digestive tract be affected, including the rectum (the rectum).
Symptoms
Abdominal pain , diarrhea with large protein , sodium and potassium losses, bowel obstruction or obstructive symptoms, blood in the stool , fever , weight loss and night sweats are common symptoms. The formation of ulcers in the intestinal wall can lead to the formation of fistulas, which can infest the abdominal cavity or - in the area of the rectum - lead to anal fistulas. In the case of unexplained abdominal pain, fever and ascites , tubercular peritonitis should therefore also be considered.
root cause
In the past, primary intestinal tuberculosis was mostly the result of bovine tuberculosis or the ingestion of milk contaminated with tubercle bacteria ( pathogen : Mycobacterium bovis ). This is due to veterinary measures but v. a. the pasteurization of milk has become extremely rare. In the epidemiological bulletin 11/2001 of the Robert Koch Institute , of 3947 culturally proven tuberculosis strains, only 51 strains (1.3%) of Mycobacterium bovis were detected. Instead, the infection of the gastrointestinal tract occurs today as a secondary form through ingestion of coughed up pathogens in pulmonary tuberculosis . Infection can also occur through the bloodstream.
Organ findings
In the Peyer's plaques of the ileozoecal region, ileocecal tuberculosis leads to tuberculous infiltration and finally to its casualty, followed by the formation of typical intestinal ulcers (so-called tuberculous ileozaecal tumors). Hyperplastic forms can simulate intestinal carcinomas.
Clarification
Stool samples are not suitable for clarifying intestinal tuberculosis. Biopsy samples are more effective.
- Ultrasound of the intestine
- Colonoscopy with biopsy
- CT of the abdomen
In terms of differential diagnosis, one should think of Crohn's disease or ulcerative colitis , as well as appendicitis .
treatment
see: tuberculosis
literature
- Hans Adolf Kühn: intestinal tuberculosis. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, p. 816 f.