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Tuberculous mesenteric lymphadenitis presenting as pyloric stenosis
1Department of Medicine, Philippine General Hospital, Manila, Philippines.
Digestive Diseases and Sciences
|September 1, 1995
Summary
Tuberculosis can cause rare pyloric stenosis, leading to vomiting and weight loss. Early diagnosis and treatment with antituberculous drugs are crucial for managing this condition.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pediatric Surgery
Background:
- Peptic ulcer disease is a common cause of upper gastrointestinal symptoms.
- Tuberculosis is typically associated with pulmonary manifestations.
Observation:
- A 17-year-old female presented with persistent projectile vomiting and weight loss.
- Initial diagnosis of peptic ulcer disease was unresponsive to treatment.
- Imaging revealed dilated stomach and duodenum, enlarged lymph nodes, and an intrahepatic mass.
Findings:
- Endoscopic biopsy showed chronic inflammation; liver biopsy was negative for acid-fast bacilli.
- Laparotomy revealed extrinsic compression of the pyloroduodenal area by lymph nodes.
- Lymph node biopsy confirmed granulomatous inflammation with caseation necrosis and Langhan's giant cells, indicative of tuberculosis.
Implications:
- Pyloric stenosis due to tuberculosis is a rare but significant consideration in endemic areas.
- Prompt diagnosis and antituberculous therapy are essential.
- Surgical intervention like gastrojejunostomy may be necessary for gastric outlet obstruction.