Ileocecal Tuberculosis Mimicking Crohn’s Disease or Vice Versa?

Abstract

In 1986, the patient was suffering chronic abdominal pain and was investigated in the Department of Surgery at the Aga Khan University Karachi, where a diagnosis of ileocecal Crohn’s disease was made. The patient lived in isolation 1000km from Karachi, and her family in Australia preferred that further treatment occur in Sydney. Investigations indicated the need for operation, which was performed (12.22.86). Right hemicolectomy with 75cm of ileum was performed for an inflammatory mass of the cecum, cecoileal fistula, and two small bowel strictures. The histology was nonspecific chronic inflammation. Tests for tuberculosis were negative. Recovery was satisfactory and the patient returned to Pakistan until 1990 when she presented with colicky abdominal pain, diarrhea, and marked loss of weight. Endoscopic and x-ray investigations now demonstrated an enteroduodenal fistula and an inflammatory stricture at the ileocolic anastomosis. Extensive tests for tuberculosis (TB), performed in Pakistan, were negative. The patient returned to Australia for further surgical treatment. The Mantoux test was positive and there was a calcified focus in the mid zone of the right lung. A 10-day period of total parenteral nutritional (TPN) therapy was administered prior to operation.