Rare case of duodenal tuberculosis causing gastric outlet obstruction, a case report

Intestinal tuberculosis (TB) comprises of about 5 % of all cases of tuberculosis in susceptible communities. Intestinal tuberculosis establishes itself in the lymphoid follicles of the Peyer's patches and spreads to the submucosal and subserosal planes. A gastroduodenal location for TB is very rare even in patients with pulmonary TB and gastroduodenal TB lesions are usually secondary.

A 48 year old Ethiopian patient presented with non-bilious, non-projectile vomiting of ingested matter which progressively worsens over time. Associated with this he had burning type of epigastric pain for which he had been treated with antiulcer drugs on multiple occasion, but he had no improvement. The vomiting worsened over the past year and he had unquantified but significant weight loss. Subsequently the patient was diagnosed with duodenal TB and was treated with antituberculous drugs according to the national protocol for six months and the above symptoms subsided. The patient had significant weight gain after starting treatment.

The commonest site for gastro-intestinal tuberculosis (TB) is the ileocecal region and duodenal tuberculosis constitutes around 2 % of cases of abdominal tuberculosis. A high index of suspicion for tuberculosis is required in any patient with gastrointestinal symptoms living in endemic areas.

We suggest that a diagnosis of duodenal tuberculosis should always be considered in young patients presenting with gastric outlet obstruction (GOO) or unresponsive or relapsing dyspepsia, in areas where tuberculosis is endemic.