Editor's quiz: GI snapshot
ANSWER
| The first 150 words of the full text of this article appear below. |
From question on page 49
The diagnosis is "granulomatous pyloro-duodenitis with caseation necrosis, findings consistent with tuberculosis".
Figure 1 shows confluent granulomas, involving the mucosa and submucosa. Figure 2 demonstrates a large area of tissue destruction due to caseous necrosis in the perigastric lymph node, with epithelioid reaction, and Langerhan’s giant cells (fig 3, arrow). Stain for acid-fast bacilli was negative. Culture was not done.
The patient was further investigated. Mantoux test produced an induration of 20 mm, and HIV testing was negative. CT scan demonstrated no involvement of the lungs or other intra-abdominal organs. He was given anti-tuberculosis (TB) therapy, gradually regained weight (6 kg in 3 months) and was well when last seen 5 months after surgery. The last CT scan performed then showed no intra-abdominal lymphadenopathy.
Gastric TB is rare (from 0.16% to 0.21% of routine autopsies) and is usually associated with pulmonary TB or immunodeficient state.
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