Clinical Analysis Of 49 Cases Of Intestinal Tuberculosis

Objective This study is to discuss the manifestation, auxiliary examination results of intestinal tuberculosis and diagnose, in order to improve the level of recognition and diagnosis, reduce the misdiagnosis and mistreatment.Methods The data of 49 cases of intestinal tuberculosis which were hospitalized during April, 2005 to Dec, 2008 in Xiangya 2nd Hospital of Central South University were analyzed retrospectively. Including general state of health, clinical manifestation, auxiliary examination results and the diagnosis.Results The male female ratio was 1.6:1; the average age was 39.1 years old; the most common symptoms were stomachache(66.1%), abdominal distention(44.9%), diarrhea(42.9%), bad appetite(42.9%); most of the first symptom was stomachache(49.0%); the most common complication is intestinal obstruction(22.4%); the major physical sign is abdominal tenderness(59.2%), most in the right lower quadrant; 59.2% of the cases complicated with parenteral tuberculosis; ESR increasing was 75.7%; PPD-IgG positive ratio was 23.7%, IgM positive ratio was 18.4%; ADA increasing was 30.0%; tuberculin test: 1:2000 positive ratio was 39.1%, 1:1000 positive ratio was 26.1%; the B-type ultrasonography of abdominal and pelvic cavity was performed in 28 cases, lesions were detected in 22 cases; CT was performed in 7 cases, lesions were detected in all; gastrointestinal graphy was performed in 24 cases, lesions were found in 20 cases; colonoscopy was performed in 42 cases, the main performance were terminal ileum or/and ileocecal junction had different size of ulcers, erosion, coarse membrana mucosa, deformed ileal valve, congestion and hydrosarca of membrana mucosa, most of them were seen ulcers, the common is annulus, most were single focus of infection, plurisegmental focus of infection appeared too, and 32 cases were got specimen for biopsy, positive ratio of pathology was 15.6%, 5 of 12 cases were found acid-fast bacilli. 16 patients of intestinal obstruction, intestinal perforation or vain diagnosis received the exploratory laparotomy and surgical operation, and 14 cases were got specimens for biopsy, positive ratio of pathology was 71.4%, 2 of 5 cases were found acid-fast bacilli, from 12 cases of lymph node biopsy at the same time ,7 cases(58.3%) had TB change.Conclusions 1.The clinical manifestations were non-specific, the chief symptom were stomachache, abdominal distention, and diarrhea; most of the first symptom was stomachache, pyrexia, night sweat, becoming thin were seldom, extraintestinal tuberculosis was helpful in diagnosis.2. The sensibility and specificity of tuberculin test and other serum test of tuberculosis were low, they only had referred role in the diagnosis of intestinal tuberculosis. 3.X-ray of barium meal or Ba enem had effect in the diagnosis, the conoloscopy had significant effect in the diagnosis of intestinal tuberculosis. 4.the final diagnosis was based on the pathology, but the positive ratio of the biopsy was low, positie ratio of biopsy from surgery was high, and the positie ratio of biopsy (including intestinal membrana mucosa and lymph node of mesenterium) from surgery was high. 5.We could diagnosis because diagnostic antituberculosis therapy was in effect.