PDF(Pubmed)
Abstract：
Tuberculosis (TB) remains a significant global health challenge. Miliary TB is a rare manifestation of TB that involves systemic lymphohematogenous dissemination of infection and presents diagnostic challenges due to its often asymptomatic or non-specific nature. This case report documents a rare occurrence of gastrointestinal (GI) bleeding secondary to miliary TB without pulmonary symptoms in an 81-year-old Filipino-American male living in the United States. Extensive imaging studies revealed a mass in the right colon with multiple bleeding vessels draped around it; it was not amendable to treatment with embolization and required right hemicolectomy with end ileostomy. The pathology report of the excised mass demonstrated miliary TB with necrotizing granulomas and granulomatous lymphadenopathy involving 23 lymph nodes. The patient was started on anti-tuberculosis medical management; however, the patient remained clinically unstable and expired on postoperative day 39. This case highlights the importance of the heightened clinical awareness required during times of globalization and in regions with dense immigrant populations. We aim to delineate the clinical understanding of gastrointestinal TB (GITB) and review possible indications for surgical management. We aim to help reduce diagnostic delay, therefore improving patient outcomes and limiting the spread of disease.
摘要：
结核病（TB）仍然是一个重大的全球卫生挑战。睫状结核是结核病的一种罕见表现，涉及感染的全身淋巴道传播，并且由于其通常无症状或非特异性而提出了诊断挑战。该病例报告记录了一名居住在美国的81岁的菲律宾裔美国男性中，罕见的胃肠道（GI）出血继发于没有肺部症状的粟粒性TB。广泛的影像学研究显示，右结肠有肿块，周围有多个出血血管；栓塞治疗是不可修正的，需要右半结肠切除术和末端回肠造口术。切除的肿块的病理报告显示，鳞茎结核伴坏死性肉芽肿和肉芽肿性淋巴结病，涉及23个淋巴结。患者开始接受抗结核医疗管理；然而，患者在临床上仍然不稳定,并在术后第39天过期.这个案例强调了在全球化时期和移民人口稠密的地区提高临床意识的重要性。我们旨在描述对胃肠道结核（GITB）的临床认识，并审查手术治疗的可能指征。我们的目标是帮助减少诊断延迟，因此改善患者的预后并限制疾病的传播。
