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What is Tuberculous Colitis?

Tuberculosis is a highly infectious disease caused due to the bacteria Mycobacterium tuberculosis. It usually affects the lungs but can also affect other parts of the body such as the colon. Tuberculous colitis is a rare condition characterized by inflammation of the colon with the formation of nodules or tubercles. The ascending colon and caecum are most commonly affected. 

Causes of Tuberculous Colitis

Tuberculous colitis usually affects people with compromised immune systems and poor health such as HIV-positive patients and those suffering from chronic illnesses. It can occur if you have pulmonary tuberculosis or as a primary infection in the colon. Infection may be caused by:

  • Ingestion of sputum infected with M. tuberculosis
  • Ingestion of contaminated food and milk products
  • Direct spread of the bacteria from an infected lymph node or organ, mostly the lung

Symptoms of Tuberculous Colitis

The bacteria penetrate the mucosal layer of the intestine and damage the cells leading to inflammation. Some of the common symptoms of tuberculous colitis include:

  • Abdominal pain
  • Bloody stool
  • Fever
  • Frequent diarrhoea
  • Low appetite
  • Night sweats
  • Rectal bleeding
  • Vomiting
  • Weight loss
  • Weakness
  • Feeling of a mass in the lower right abdomen
  • Colon perforation
  • Colon obstruction 

Diagnosis of Tuberculous Colitis

Your doctor will review your symptoms, medical history and perform several diagnostic tests to confirm the condition. That includes:

  • Skin test: In a tuberculin skin test, tuberculin fluid is injected in a small amount into the skin. The skin reaction at the site of the injection is then examined after a few days to detect tuberculosis infection.
  • Blood test: A blood sample can also be evaluated in the laboratory to detect tuberculosis. Additionally, a complete blood count is evaluated to determine if bleeding, infection and inflammation is present.
  • The stool and sputum may be tested for acid-fast bacilli (tuberculosis bacteria).
  • A chest X-ray is performed to look for pulmonary TB. 
  • CT scan: This is a specialized x-ray technique that produces clear images of the colon.
  • Barium enema: An X-ray examination using barium which can show changes in the affected region of the colon.
  • Colonoscopy: A thin flexible light tube with a camera attached to its end will be inserted through your rectum into your colon to view any lesions and internal bleeding. Usual findings in tuberculosis colitis include areas with inflammation, bleeding, ulcerations, nodules, or constriction due to tissue growth (hypertrophy).  
  • Biopsy: A small tissue sample (biopsy) will be taken from the colon for examination under a microscope and for further analysis. Tuberculous colitis may show granulomas/abscess and acid-fast bacilli. 

Treatment for Tuberculous Colitis

Treatment for tuberculous colitis includes:

  • Anti-tuberculosis medications: Your doctor will prescribe anti TB drugs as the primary step in treatment for up to nine months. First-line anti TB drugs are used to treat new patients and more aggressive drugs are prescribed for patients suffering from drug-resistant TB.
  • Endoscopic balloon dilation: To treat colon constriction.

Surgery may be recommended in case of colon perforation or non-resolving abscesses or intestinal obstruction. It includes:

  • Ileotransverse anastomosis: In this surgery, the ileum is connected to the transverse section of the colon in order to bypass the affected portion of the ascending colon.
  • Hemicolectomy: In this surgery, the infected part of the colon will be removed and the adjacent segments are reattached.
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