Tuberculosis of the intestine is a chronic specific infection caused by the invasion of Mycobacterium tuberculosis. The vast majority of cases are secondary to pulmonary tuberculosis, especially open pulmonary tuberculosis. The disease predominantly affects young adults, with a higher incidence in females than in males, approximately 1.85:1. Pathologically, it is classified into three types: ulcerative, hyperplastic, and mixed.

bubble_chart Diagnosis

Medical history and symptoms:

Dull pain in the right lower abdomen or periumbilical region, often induced after eating. In cases with incomplete intestinal obstruction, abdominal pain is persistent and intermittently aggravated. Changes in bowel habits, diarrhea with pasty stools that may contain mucus, without tenesmus; hematochezia is rare. Alternating diarrhea and constipation may occur. Proliferative intestinal tuberculosis often presents primarily with constipation. Symptoms may include fever, night sweats, weight loss, general lack of strength, nausea, vomiting, abdominal distension and fullness, and decreased appetite. Additionally, inquire about any history of subcutaneous nodules, previous examinations and treatments, whether anti-tuberculosis therapy was administered, and the duration and efficacy of treatment.

Physical examination findings:

Fixed tenderness in the right lower abdomen. In cases complicated by intestinal obstruction, hyperactive borborygmi, visible intestinal loops, and peristaltic waves may be present. Proliferative intestinal tuberculosis may present with a palpable mass in the right lower abdomen, usually fixed, moderately firm, and accompanied by varying degrees of tenderness. Signs of anemia may also be present. A detailed examination of the patient's signs helps assess the severity of the condition and the pathological type of intestinal tuberculosis.

Auxiliary examinations:

Most cases are accompanied by mild to grade II anemia. The white blood cell count is generally normal, with elevated lymphocytes. The erythrocyte sedimentation rate (ESR) is often significantly increased and serves as an indicator of disease activity. In ulcerative intestinal tuberculosis, white blood cells and pus cells may be seen in the stool, and stool concentration may yield positive results for Mycobacterium tuberculosis. X-ray findings include thickening, disorganization, or destruction of the mucosal membrane, skip lesions of barium in the affected area, or thickening, nodules, and deformation of the intestinal wall. Fibrocolonoscopy may reveal lesions in the ascending colon, cecum, and terminal ileum. The presence of caseating granulomas on biopsy is of significant diagnostic value.

bubble_chart Treatment Measures

Rest and Nutrition:

Patients with active intestinal tuberculosis should rest in bed, actively improve their nutrition, and receive intravenous hyperalimentation therapy if necessary to enhance resistance.

Chemotherapy:

The common regimen includes isoniazid 0.3g orally once daily and rifampin 0.45g orally once daily for combined chemotherapy, with a course of 6–9 months. For severe intestinal tuberculosis or cases accompanied by extrapulmonary subcutaneous lymph node involvement, streptomycin 0.75g IM once daily, or pyrazinamide 0.5g orally three times daily, or ethambutol 0.25g orally three times daily is usually added.

Symptomatic Treatment:

For abdominal pain, belladonna 16mg orally three times daily or 654-2 10mg IM may be used. For severe diarrhea, fluid replacement and correction of electrolyte imbalances are necessary.
Patients with complications such as complete intestinal obstruction, acute perforation, or massive hemorrhage should undergo prompt surgical treatment.