Intestinal tuberculosis: a diagnostic challenge

Trop Med Int Health. 2017 Aug;22(8):994-999. doi: 10.1111/tmi.12908. Epub 2017 Jul 5.


Objective: To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country.

Method: Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital.

Results: Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology.

Conclusion: Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.

Keywords: TB; London; Londres; abdominal; gastro-intestinal; gastrointestinal; tuberculosis.

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / etiology
  • Adult
  • Africa / ethnology
  • Anus Diseases / etiology
  • Demography
  • Diagnosis, Differential
  • Emigrants and Immigrants
  • Female
  • Humans
  • India / ethnology
  • Intestines / microbiology
  • Intestines / pathology*
  • London / epidemiology
  • Male
  • Retrospective Studies
  • Transients and Migrants
  • Tuberculosis, Gastrointestinal / complications
  • Tuberculosis, Gastrointestinal / diagnosis*
  • Tuberculosis, Gastrointestinal / epidemiology
  • Tuberculosis, Gastrointestinal / microbiology
  • Tuberculosis, Pulmonary / complications