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|Year : 1979 | Volume
| Issue : 1 | Page : 61-62
RC Mankodi1, NN Shah2, MS Patil2, DR Daftary1
1 Department of Pathology, Dr.B.Nanavati Hospital, Vile-Parle (West), Bombay 400056, India
2 Department of Surgery, Dr.B.Nanavati Hospital, Vile-Parle (West), Bombay 400056, India
R C Mankodi
Department of Pathology, Dr.B.Nanavati Hospital, Vile-Parle (West), Bombay 400056
Source of Support: None, Conflict of Interest: None
A female aged 45 years was admitted to the hospital with chronic diarrhoea. Probable diagnosis of rectal carcinoma was made on clinical and radiologic examination. Biopsy showed histology of tuberculosis. Patient was treated by antituberculous drugs with remarkable improvement.
|How to cite this article:|
Mankodi R C, Shah N N, Patil M S, Daftary D R. Rectal tuberculosis. J Postgrad Med 1979;25:61-2
| :: Introduction|| |
Isolated tuberculous involvement of the colon is an uncommon condition. It affects caecum, ascending colon, descending colon and rectum with decreasing frequency. Clinically colonic tuberculosis often mimics malignancy. Its histologic picture simulates other chronic granulomas, however the presence of caseation is diagnostic. We report here, a case of rectal tuberculosis because of its rarity and interesting clinical features.
| :: Case Report|| |
A 45 year old female patient was admitted to Dr. Balabhai Nanavati Hospital with complaints of loose motions with mucus of eight months' duration. She also had urgency of defaecation. There was no history of passing blood. There was no history of tuberculosis.
On examination, the patient was found to be undernourished and showed marked pallor. Systemic examination revealed no abnormalities. There was no lymphadenopathy. On rectal examination, an annular stricture was felt at six cms. above the anal verge. Proctoscopy showed smooth pale mucosal lining.
Investigations showed her haemoglobin to be 7.1 Gm. per cent. Total leukocyte count was 4600/cmm. with P: 69, F: 9, L: 20, M: 2; E.S.R. was 80 mm. after 1st hour (Westergren). Stool analysis showed plenty of mucus with a few pus cells. Her plain X-Ray of chest was normal. Barium enema showed a well defined stricture in the rectum with dilatation of the proximal segment (see [Figure 1] on page 62A). Clinical impression was of malignancy. Rectal biopsy was carried out to confirm the diagnosis.
Pathology Report: Biopsy showed mucosa lined by normal rectal glands. Submucosa showed a collection of chronic inflammatory cells. Also seen was a well formed tubercle with central caseation (see [Figure 2] and [Figure 3] on page 62A). Diagnosis of tuberculosis was made, showed normal ileocaecal junction.
Later Barium meal study was carried out. It
Patient was treated with antituberculous drugs. Patient showed marked improvement within a month's time.
| :: Discussion|| |
Gastrointestinal tuberculosis occurs mainly as a complication of pulmonary tuberculosis and rarely as a primary entity. In India the primary variety has been detected in 0.02 to 5.1 per cent of unselected autopsies.  Isolated colonic tuberculosis is rather an uncommon disease. Hancock  in summarising the world literature, was able to find only 63 cases of isolated colonic tuberculosis. Subsequently, additional 20 cases have been reported.  Chawla et a1  reported that only 87 cases of segmental tuberculosis of the distal colon were reported in the English literature till 1971. Colonic tuberculosis most frequently involved the caecum, with decreasing frequency, in the ascending colon, descending colon and rectum.  Indian literature showed only occasional report of colonic tuberculosis. ,
Colonic tuberculosis can occur in two forms, hyperplastic and ulcerative. The latter is very rare. Hyperplastic tuberculous colitis is often confused with other specific and non-specific granulomatous colitis; however, in the present case a well formed tubercle with central caseation posed no diagnostic problems.
Clinical diagnosis in the present case was of suspected colonic malignancy. Rectal biopsy proved diagnostic. Absence of the involvement of ileo-caecal region on Barium meal study, presence of caseation on histologic examination and clinical improvement following antituberculous drugs conclusively proved the present case to be of primary rectal tuberculosis.
| :: Acknowledgements|| |
Authors are thankful to Dean Dr. S. C. Sheth for allowing to publish this case report.
| :: References|| |
|1.||Abrams, J. A. and Holden, W. D.: Tuberculosis of the gastro-intestinal tract. Arch. Surg., 89: 282-293, 1964. |
|2.||Ahuja, S. K., Gaiha, M., Sachdev, S. and Meheshwari, H. B.: Tuberculous colitis simulating ulcerative colitis, A case report. J. Assoc. Phys. India, 24: 617-619, 1976. |
|3.||3, Brenner, S. M., Annes, G. and Parkar, J. G.: Tuberculous colitis simulating non-specific granulomatous disease of the colon. Amer. J. Dig. D's., 15: 85-89, 1970. |
|4.||Chawla, S., Mukerjee, P. and Berry, K.: Segmental tuberculosis of the colon. Clin. Radiol.. 22: 104-107, 1971. |
|5.||Gupta, S. and Vyas, P. B.: Primary hyperplastic tuberculosis of the colon. J. Assoc. Phys. India, 16: 617-619, 1968. |
|6.||Hancock, D. M.: Hyperplastic tuberculosis of the distal colon. Brit. J. Surg., 46: 63-68. 1958. |
|7.||Ukil, A. C.: Early diagnosis and treatment of intestinal tuberculosis. Ind. Med. Gaz. 77: 613, 1947-as quoted by Gupta and Vyas. 5 |
[Figure 1], [Figure 2], [Figure 3]