NADİR GÖRÜLEN BİR AKCİĞER DIŞI TÜBERKÜLOZ OLGUSU: İNTESTİNAL TÜBERKÜLOZ

Yıl 2015, Cilt: 29 Sayı: 2, 95 - 99, 01.10.2015

Ferhat Ekinci Feyza Arslan Alper Aygen Utku Erdem Soyaltın Coşkun Yıldız Ümit Bayol Alp Özgüzer Harun Akar

Öz

Tüberküloz (TBC); tüm dünyada insidansı halen artmakta olan önemli bir sağlık sorunudur. Akciğer dışı yerleşimli tüberküloz olgularına geçmişe nazaran çok daha sık rastlanmaktır. İntestinal tüberküloz gelişmekte olan ülkelerde halen görülmekte olan ve vakaların yaklaşık 1/3'ünde pulmoner tüberkülozun eşlik ettiği bir hastalıktır. Gastrointestinal sistem (GİS) tüberkülozu karın ağrısı, diyare, kilo kaybı, gece terlemesi ve nadiren GİS kanama şeklinde karşımıza çıkabilir. İntestinal tüberkülozun, başlıca enflamatuar barsak hastalıkları olmak üzere pek çok hastalıkla klinik benzerlik göstermesi nedeniyle tanısı zordur. GiS tüberkülozunun tanısı zor olabilir ve tanıda en önemli öğe TBC' nin akla getirilmesidir. Karın ağrısı, ishal, halsizlik, kilo kaybı, asit ile karşımıza gelen GIS tüberkülozu tanısı alan olgumuzu tartışmak istedik.

Anahtar Kelimeler

Akciğer dışı tüberküloz, asit

A RARE CASE OF EXTRA-PULMONARY TUBERCULOSIS: INTESTINAL TUBERCULOSIS

Öz

Tuberculosis (TB) is an important health issue with a rising incidance all around the world. Extrapulmonary tuberculosis cases are encountered much more frequently compared to past. Intestinal tuberculosis (IT) is still seen in developing countries, and approximately one-third of the cases are accompanied by pulmonary tuberculosis. Gastrointestinal system (GIS) tuberculosis may present as abdominal pain, diarrhea, weight loss, nighttime sweating and rarely GIS bleeding. The diagnosis of IT is difficult because it mimics many other disorders especially inflammatory bowel diseases. The diagnosis of the GIS tuberculosis may be difficult. The most important entity in the diagnosis is to consider TB. We would like to discuss our case diagnosed as GIS tuberculosis presenting with abdominal pain, diarrhea, fatigue, weight loss, ascite.

Anahtar Kelimeler

Extrapulmonary tuberculosis, ascite

Kaynakça

• 1. Fanning A. Tuberculosis: 6 extrapulmonary dissease. CMAJ 1999; 160:1597-1603.
• 2. Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004;120:305-15.
• 3. J Cai, F Li, W Zhou, H-S Luo. Ileocecal Ulcer in Central China: Case Series. Dig Dis Sci, C Springer Science+Business Media, Inc. 2006.
• 4. Namisaki T, Yoshiji H, Fujimoto M, et al. Two cases of colonic tuberculosis presenting with massive melena. Int J Clin Pract 2004;58:1162- 64.
• 5. Todd AS, Walter JC. Gastrointestinal tuberculosis. Current Gastroenterology Reports 2003;5:273- 7.
• 6. Leung VK, Law ST, Lam CW, et al. Intestinal tuberculosis in a regional hospital in Hong Kong: a 10 year experience. Hong Kong Med J 2006; 12: 264-71./// Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis - presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005; 22: 685-700
• 7. Namisaki T, Yoshiji H, Fujimoto M, et al. Two cases of colonic tuberculosis presenting with massive melena. Int J Clin Pract 2004;58:1162- 4.
• 8. Chatzicostas C, Koutroubakis IE, Tzardi M, et al. Colonic tuberculosis mimicking Crohn's disease: case report. BMC 2002;2:1-4./// Shah S, Thomas V, Mathan M, et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut1992;33:347-51.
• 9. Jain R, Sawhney S, Bhargava DK et al. Diagnosis of abdominal tuberculosis: sonographic findings in patients with early diagnosis. AJR Am J Roentgenol 1995; 165:1391-5.
• 10. Comert FB, Comert M, Kulah C, et al. Colonic tuberculosis mimicking tumor perforation: A case report and rewiew of the literature. Digestive Dis Sci 2006;51:1039-42.
• 11. Bolukbas C, Bolukbas FF, Kendir T, et al. Clinical presentation of abdominal tuberculosis in HIV seronegative adults. BMC Gastroenterol 2005;5: 21.
• 12. Demir K, Okten A, Kaymakoglu S, et al. Tuberculous peritonitis-reports of 26 cases, detailing diagnostic and therapeutic problems. Eur J Gastroenterol Hepatol 2001;13: 581-5
• 13. Yonal O, Hamzaoglu HO. What is the most accurate method for the diagnosis of intestinal tuberculosis? Turk J Gastroenterol 2010; 21: 91-6.
• 14. Subnis BM, Bakhshi GD, Shaikh A, et al. Bombay Hospital Journal Special Issue 2009;78-80.
• 15. Riquelme A, Calvo M, Salech F, et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tubercular peritonitis: a metaanalysis. J Clin Gastroenterol 2006; 40: 705- 10.
• 16. Namisaki T, Yoshiji H, Fujimoto M, et al. Two cases of colonic tuberculosis presenting with massive melena. Int J Clin Pract 2004;58:1162- 4.
• 17. Saenz EV, Magro PMH, Fernandez JFAT, Ovalle MV. Colonic tuberculosis. Digestive Dis Sci 2002;47:2045-8.
• 18. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993; 88:989-99.
• 19. Bhargava DK, Tandon HD, Chawala TC, et al. Diagnosis of ileocecal and colonic tuberculosis by colonoscopy. Gastrointest Endosc 1985; 31: 68-70.
• 20. Pulimood AB, Peter S, Ramakrishna B, et al. Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease. J Gastroenterol Hepatol 2005;20: 688-96.
• 21. Machado N, Grant CS, Scrimgeour E. Abdominal tuberculosis- experience of a university hospital im Oman. Acta Tropica 2001;80:187-190/// Bhargawa DK, Shriniwas S, Chopra P et al. Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol 1992; 87: 109-12.
• 22. Lisehora GB, Peters CC, Lee YT et al: Tuberculous peritonitis – do not miss it. Dis Col Rectum 1996;39: 394-9.