Lakeland Regional Health Medical Center Lakeland, FL
Omar Zuhdi, MD1, Juan Carlos Rivera-Martinez, MD1, Amanda Rigdon, MD1, Camila Villacreses, DO1, Paola Campillo, MD1, Sai Wan, MD2 1Lakeland Regional Health Medical Center, Lakeland, FL; 2Lakeland Regional Health, Lakeland, FL Introduction: Abdominal tuberculosis can present with a wide range of manifestations affecting the gastrointestinal tract ranging from abdominal pain and diarrhea to perforation, abscesses, and small bowel obstructions. Abdominal tuberculosis should be considered in patients presenting with symptoms such as fever, weight loss, abdominal pain, and hepatomegaly in patients with known TB exposure or travel from a TB endemic area. Early diagnosis of abdominal tuberculosis is important to prevent complications including perforation, fistulas, or obstruction.
Case Description/
Methods: The patient is a 74-year-old female from Myanmar, with a history of TB who presented due to nausea, vomiting, and abdominal pain. She was recently diagnosed with active TB a few days prior, but had not yet started treatment. The patient had a recent stool test outpatient which was positive for TB. During this admission, the CT of the abdomen showed a distended small bowel measuring up to 5.6 cm, air fluid levels throughout the abdomen, and a transition point in the lower posterior pelvis. A nasogastric tube was placed and the patient was started on IV rifampin, levofloxacin, amikacin, and linezolid. Follow-up abdominal x-ray showed resolution of the small bowel obstruction and the patient was sent home on oral TB therapy. Two weeks following discharge, the patient presented with vomiting, abdominal pain, and distention. Abdominal x-ray showed evidence of a small bowel obstruction with distention of the small bowel up to 4.8 cm in diameter. The patient’s IV TB regimen was restarted with successful resolution of her small bowel obstruction. Discussion: Due to the rarity of intestinal tuberculosis in the United States, misdiagnosis can delay initiation of treatment resulting in worsening outcomes. Patients with abdominal TB should be treated with anti-tuberculous therapy in the same manner as that of pulmonary TB. However, surgery may be indicated in patients presenting with complications including perforation, fistulas, or obstruction. Patients presenting with multiple strictures have been reported to be less likely to respond to anti-TB therapy and in certain instances, these medications may worsen the obstruction. Intestinal TB may be difficult to diagnose as it can present similarly to pathologies such as intra-abdominal infection, IBD, or malignancy. Misdiagnosis rates of intestinal tuberculosis have been reported to be as high as 50-70%, even in countries with a high prevalence of tuberculosis.
Disclosures: Omar Zuhdi indicated no relevant financial relationships. Juan Carlos Rivera-Martinez indicated no relevant financial relationships. Amanda Rigdon indicated no relevant financial relationships. Camila Villacreses indicated no relevant financial relationships. Paola Campillo indicated no relevant financial relationships. Sai Wan indicated no relevant financial relationships.
Omar Zuhdi, MD1, Juan Carlos Rivera-Martinez, MD1, Amanda Rigdon, MD1, Camila Villacreses, DO1, Paola Campillo, MD1, Sai Wan, MD2. P6286 - Recurrent Small Bowel Obstruction Secondary to Intestinal Tuberculosis: A Case Report and Review of the Literature, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
