1. Tb enteritis
Department of Surgery

2. Timeline Showing Highlights of Robert Koch's Work and the Ongoing Threat Posed by Tuberculosis.
Since the Nobel Prize was awarded to Koch in 1905, several advances have been made against tuberculosis. By 1921, a viable attenuated vaccine had been developed by Albert Calmette and Camille Guerin; it protects against severe forms of tuberculosis in newborns but does not prevent pulmonary tuberculosis in adults. The first tuberculostatic drug was developed by Selman Waksman in 1943, and chemotherapy became possible. But because prolonged treatment with multiple drugs is required, compliance is often incomplete, leading to an increasing incidence of multidrug-resistant disease. In 1998, the genome of Mycobacterium tuberculosis was sequenced, providing the blueprint for the development of an improved vaccine and new drugs.

3. Introduction Still common in impoverished areas of the world
6th extrapulmonary site
Lymphatic > GU > bone and joint > miliary > meningeal
Tuberculosis involving GI tract
Mycobacterium tuberculosis
Primary to lung + swallowing of sputum
Mycobacterium bovis
Swallowing non-pasteurized milk
Prevalence
Socioeconomic status
Poor hygiene & overcrowding, unpasteurized milk
Recent dramatic increase
HIV/AIDS(9% of all new TB cases)
Travel & migration

4. Clinical manifestations
Most common site ; ileocecal region
presence of abundunt lymphoid tissue
increased physiologic stasis
increased rate of absorption in the proximal bowel
Symptoms and Findings
Abdominal pain ;
usually hypogastrium, frequently localized to RLQ
Anorexia, fever, weight loss
Bowel obstruction
Ascites
Palpable mass (usually RLQ)
Ulceration, stricture

5. Evaluations Requires a high index of suspicion Plain X ray
Pulmonary lesion
Stool AFB
Positive tuberculin test
Plain X ray
Intestinal obstruction
Free perforation with pneumoperitoneum
Barium enema
Obstruction, stricture, conical cecum
Ulcer; aligned in a transverse or circumferential pattern, involving Rt colon and deformity of IC valve

7. Evaluations USG ; pseudokidney sign CT Endoscopy (DDx from CD)
a strong echogenic center surrounded by a sonolucent rim CT
Acites, intra- and extraperitoneal lymphadenopathy, ileocecal wall thickening, and thickening and calcifications on peritoneal surfaces
Endoscopy (DDx from CD)
Colonoscopic FNAC ; to identify AFB
PCR
Laparoscopy
Useful procedure for tuberculous peritonitis

11. Histopathology
Generally, macroscopic appearance of the cecum is indistinguishable from that of CD, but the diagnosis may be established by histologic examination.
Resected specimen
Thickening of the bowel wall, mucosal ulceration, localized segmental disease, or skip lesions
Classical histologic criteria
Presence of submucosal or serosal Langerhans giant cell
Presence of caseous necrosis

14. Treatment Medical therapy Surgery Uncomplicated case
Conventional antituberculous agents
50 % may be adequately treated with medical therapy alone
Ulcerating lesions are more likely to respond to medical therapy than hypertropic form
Surgery
Should be limited to symptomatic localized disease.
Supicious cancerous lesion

15. Diagnostic approach to Tb peritonitis