Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

ABDOMINAL IMAGING
Year
: 2004  |  Volume : 14  |  Issue : 1  |  Page : 55--56

Case report : Gastric tuberculosis - rare manifestation


SC Godara, RA George, M Uniyal 
 Dept. of Radiology and Imaging, Command Hospital (EC), Alipore, Kolkata (WB) 700027, India

Correspondence Address:
S C Godara
Dept. of Radiology and Imaging, Command Hospital (EC), Alipore, Kolkata (WB) 700027
India




How to cite this article:
Godara S C, George R A, Uniyal M. Case report : Gastric tuberculosis - rare manifestation.Indian J Radiol Imaging 2004;14:55-56


How to cite this URL:
Godara S C, George R A, Uniyal M. Case report : Gastric tuberculosis - rare manifestation. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Nov 18 ];14:55-56
Available from: http://www.ijri.org/text.asp?2004/14/1/55/28556


Full Text

 Introduction



Gastric Tuberculosis, whether as a primary or secondary infection, is uncommon [1]. It is usually associated with Pulmonary TB or with immunodeficiency states [2]. We present a case of Gastric TB with the uncommon appearance of a granulomatous mass in a young, immunocompetent individual.

 Case report



A 22-year-old male presented with complaints of vague abdominal pain in the epigastric region for the past six months and was being treated medically as a case of gastritis. There was a history of weight loss to the tune of 8 Kgs in these six months. CT scan of the abdomen revealed thickening of the gastric wall along the lesser curvature [Figure 1], which, on reformatted images showed a polypoidal growth in the prepyloric region [Figure 2].

CT scan also revealed extensive retroperitoneal lymphadenopathy [Figure 3]. Endoscopy revealed a polypoidal growth in the prepyloric region. Biopsy taken was positive for AFB on ZN stain and HPE showed caseation necrosis with Langerhans giant cells confirming the diagnosis of Gastric TB [Figure 4].

 Discussion



Gastric TB is a rare entity even in India. It comprises only 0.2-1 % of patients with Gastro-intestinal TB. Postulated reasons for rarity of gastric TB are the presence of acidic medium, scarcity of lymphoid tissue in the stomach, integrity of gastric mucosa and active gastric motility. Possible routes of infection are by direct infection of mucosa, hematogeneous spread and extension from neighbouring TB lesion.

Early diagnosis is often missed because of varied non-specific manifestations of the disease [3]. It usually mimics peptic ulcer disease [4] or malignancy though occasionally it can manifest as PUO [5] or Gastric outlet obstruction. [3]

Tuberculosis may affect any part of Gastro-intestinal tract but Gastric involvement is very uncommon [6]. Tubercle formation in the submucosa leads to papillary elevations of the mucosa resulting in a protuberant mass, which in turn ulcerates due to a combination of localized endarteritis and lymphangitis [7]. The ulcers may enlarge and produce undermined edges resembling carcinoma. Deep ulceration with little or no surrounding active fibrosis may give rise eventually to sub-serosal tubercles and adhesions

Tuberculous lesions of stomach are usually located in the lesser curvature of the antrum and often involve the duodenum. Pyloric ulcers may cause gastric outflow obstruction. Fibrotic tuberculosis can resemble linitus plastica or lymphoma. A granulomatous mass may occur but this is least common appearance; sooner or later these granulomas will ulcerate and they are usually diagnosed as malignant gastric ulcers [7]. External pressure on stomach may be due to enlarged lymph nodes. The differential diagnoses to be considered besides gastric carcinoma, are Crohn`s disease, Sarcoidosis, Syphilis, Mycotic lesions and exposure to Beryllium and Silicates [6].

References

1Palmer D, TB of stomach and the stomach in TB; Am Rev Tubercl 1950:61:116-30
2Brody J M,Miller D K Gastric TB: A manifestation of Acquired immunodeficiency syndrome.Radiology 1986,159:347-348
3Okoro E O,Komolafe O F:Gastric TB:unusual presentation in two patients.Clin Radiol,1999,54:257-9
4Chetri K,Prasad K K,Jain M,Chaudhari G:Gastric TB presenting as non-healing ulcer:case report:Trop Gastroenterol 2000:21:180-1
5Salpeter S R,Shapiro R M.Gastric TB presenting as PUO.West J Med.1991;155:412-3
6Primary gastric TB-report of 5 cases.Deepak N Amarapurkar,Nikhil D Patel,Anjali D Amarapurkar;BMC Gastroenterology 2003 3:6
7A textbook of Radiological diagnosis,5th Ed,Vol 4,British Authors