Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature
Abstract Background Duodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucia...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-02-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-024-01840-x |
| _version_ | 1797273458667683840 |
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| author | Nami Sato Masayuki Shiobara Kazuo Wakatsuki Kosuke Suda Kotaro Miyazawa Toshiaki Aida Yoshihiro Watanabe Katsunobu Tawada Yoshiki Matsubara Yohei Hosokawa Shigeru Yoshioka |
| author_facet | Nami Sato Masayuki Shiobara Kazuo Wakatsuki Kosuke Suda Kotaro Miyazawa Toshiaki Aida Yoshihiro Watanabe Katsunobu Tawada Yoshiki Matsubara Yohei Hosokawa Shigeru Yoshioka |
| author_sort | Nami Sato |
| collection | DOAJ |
| description | Abstract Background Duodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucial. However, this is often overlooked. Case presentation A 35-year-old man presented with abdominal pain, fullness, vomiting, and weight loss. Upper gastrointestinal endoscopy and radiography revealed nearly pinpoint stenosis with edematous and reddish mucosa in the D1/D2 portion of the duodenum. Computed tomography (CT) showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph nodes, and portal vein stenosis. Conventional mucosal biopsy during endoscopy revealed ulcer scars. We initially suspected stenosis due to peptic ulcers; however, chest CT revealed cavitary lesions in both lung apices, suggesting tuberculosis. Due to the suspicion of duodenal TB and the need to obtain deeper tissue samples, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The tissue sample showed caseating granulomas with multinucleated giant cells, and acid-fast bacilli were positive by Ziehl–Neelsen staining. The patient was diagnosed with duodenal TB and subsequent GOO. Because the patient had difficulty eating, surgical intervention was prioritized over antitubercular drugs, and laparoscopic gastrojejunostomy was performed. The patient started an oral diet on the 3rd postoperative day and began antitubercular treatment immediately after discharge on the 11th day. During the 6th month of treatment, endoscopic examination revealed residual duodenal stenosis; however, the bypass route functioned well, and the patient remained asymptomatic. Conclusions An aggressive biopsy should be performed to diagnose duodenal TB. EUS-FNA has proven to be a useful tool in this regard. Both nutritional improvement and antitubercular treatment were achieved early and reliably by performing laparoscopic gastrojejunostomy for duodenal TB with GOO. |
| first_indexed | 2024-03-07T14:43:33Z |
| format | Article |
| id | doaj.art-4b855a8ba04c42849c3b4c2c5389b63a |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-03-07T14:43:33Z |
| publishDate | 2024-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-4b855a8ba04c42849c3b4c2c5389b63a2024-03-05T20:05:51ZengSpringerOpenSurgical Case Reports2198-77932024-02-011011910.1186/s40792-024-01840-xDuodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literatureNami Sato0Masayuki Shiobara1Kazuo Wakatsuki2Kosuke Suda3Kotaro Miyazawa4Toshiaki Aida5Yoshihiro Watanabe6Katsunobu Tawada7Yoshiki Matsubara8Yohei Hosokawa9Shigeru Yoshioka10Department of Surgery, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalDepartment of Gastroenterology, Chiba Kaihin Municipal HospitalDepartment of Gastroenterology, Chiba Kaihin Municipal HospitalDepartment of Pathology, Chiba Kaihin Municipal HospitalDepartment of Surgery, Chiba Kaihin Municipal HospitalAbstract Background Duodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucial. However, this is often overlooked. Case presentation A 35-year-old man presented with abdominal pain, fullness, vomiting, and weight loss. Upper gastrointestinal endoscopy and radiography revealed nearly pinpoint stenosis with edematous and reddish mucosa in the D1/D2 portion of the duodenum. Computed tomography (CT) showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph nodes, and portal vein stenosis. Conventional mucosal biopsy during endoscopy revealed ulcer scars. We initially suspected stenosis due to peptic ulcers; however, chest CT revealed cavitary lesions in both lung apices, suggesting tuberculosis. Due to the suspicion of duodenal TB and the need to obtain deeper tissue samples, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The tissue sample showed caseating granulomas with multinucleated giant cells, and acid-fast bacilli were positive by Ziehl–Neelsen staining. The patient was diagnosed with duodenal TB and subsequent GOO. Because the patient had difficulty eating, surgical intervention was prioritized over antitubercular drugs, and laparoscopic gastrojejunostomy was performed. The patient started an oral diet on the 3rd postoperative day and began antitubercular treatment immediately after discharge on the 11th day. During the 6th month of treatment, endoscopic examination revealed residual duodenal stenosis; however, the bypass route functioned well, and the patient remained asymptomatic. Conclusions An aggressive biopsy should be performed to diagnose duodenal TB. EUS-FNA has proven to be a useful tool in this regard. Both nutritional improvement and antitubercular treatment were achieved early and reliably by performing laparoscopic gastrojejunostomy for duodenal TB with GOO.https://doi.org/10.1186/s40792-024-01840-xDuodenal tuberculosisEndoscopic ultrasound-guided fine-needle aspirationGastric outlet obstructionLaparoscopic surgeryMycobacterium tuberculosis |
| spellingShingle | Nami Sato Masayuki Shiobara Kazuo Wakatsuki Kosuke Suda Kotaro Miyazawa Toshiaki Aida Yoshihiro Watanabe Katsunobu Tawada Yoshiki Matsubara Yohei Hosokawa Shigeru Yoshioka Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature Surgical Case Reports Duodenal tuberculosis Endoscopic ultrasound-guided fine-needle aspiration Gastric outlet obstruction Laparoscopic surgery Mycobacterium tuberculosis |
| title | Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature |
| title_full | Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature |
| title_fullStr | Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature |
| title_full_unstemmed | Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature |
| title_short | Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature |
| title_sort | duodenal tuberculosis with gastric outlet obstruction a case report of successful diagnosis and treatment with review of literature |
| topic | Duodenal tuberculosis Endoscopic ultrasound-guided fine-needle aspiration Gastric outlet obstruction Laparoscopic surgery Mycobacterium tuberculosis |
| url | https://doi.org/10.1186/s40792-024-01840-x |
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