Differential Diagnosis: Intestinal Tuberculosis



Fig. 4.1
Circumferential-shaped ulcers in ITB. (a) Deep transverse ulcer travels colonic lumen about half. (b) Wide transverse ulcer encircling colonic lumen. (c) Shallow circumferential ulcer encircling colonic lumen is noted. (d) Circumferential-shaped ulcer is noted in the terminal ileum



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Fig. 4.2
Multiple ulcers with circumferential arrangement. (a) Multiple ulcers are arranged in a transverse direction. (b) Several active ulcers are arranged in a circular direction accompanying nodular change and hyperemia. (c) Two active ulcers are arrayed in a circumferential direction accompanying luminal narrowing. (d) Multiple active ulcers are circumferentially positioned encircling colonic lumen


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Fig. 4.3
Various shapes of ulcers in ITB. (a) Geographic-shaped ulcer contiguous to the ileocecal valve. Scarring change of cecum is also observed. (b) Starlike-shaped ulcer in the colon accompanying nodular change. (c) Round-shaped ulcer in the cecum base. (d) Irregular-shaped ulcers with exudate. (e) Square-shaped ulcer. Pseudopolyps and scarring change also are noted. (f) Longitudinal-shaped ulcer in the terminal ileum


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Fig. 4.4
Small ulcers in ITB. (a) Small ulcers in the colon. (b) Aphthous lesions with scarring change and inflammatory polyps. Irregular vascularity is also observed on scar


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Fig. 4.5
Ulcerohypertrophic type of ITB. (a) A protruding polypoid mass with surface nodularity is noted at the ileocecal area. On adjacent mucosa, discrete and deep ulcerations are accompanied. (b) Colonoscopic findings after 2 months of antituberculous treatment. The size of the polypoid mass (a) is reduced, and active ulcer is healed into scar


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Fig. 4.6
Patulous ileocecal valve. (a) Widely opened ileocecal valve with adjacent active ulcer and cecal scarring change. (b) Fixed opening of ileocecal valve was observed accompanying adjacent deep ulcers with friability and nodular change. (c) Fixed opening of ileocecal valve with inflammatory polyps. Scarring change with pseudodiverticula is also noted in the cecum. (d) Patulous ileocecal valve and multiple pseudodiverticula are noted after completion of antituberculous chemotherapy


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Fig. 4.7
Strictures in ITB. (a) Ileocecal valve stenosis with active ulcer was noted. Colonoscope could not pass ileocecal valve. (b) Active ulcer in the ileocecal valve (figure a) was healed into scar after 6 months of antituberculous therapy. Ileocecal stricture was more worsened. (c) Luminal stricture with active ulcer in the hepatic flexure. (d) Luminal stricture with circumferential ulcer in the ascending colon. (e) Active transverse ulcer with stricture preventing colonoscope passage in the descending colon. (f) After completion of 6 months of antituberculous therapy, although active ulcer (figure e) was completely healed, luminal stricture is still sustained. (g) A wide circumferential ulcer in the proximal transverse colon. (h) After 2 months of antituberculous therapy, active ulcer (figure g) was substantially healed into scar; however, newly developed luminal narrowing was observed


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Fig. 4.8
Scars in ITB. (a) Diffuse scarring change in the ascending colon. (b) Scar in the colon. (c) Circumferential scar with inflammatory polyps. (d) Circular scar with multiple inflammatory polyps

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May 13, 2017 | Posted by in GENERAL SURGERY | Comments Off on Differential Diagnosis: Intestinal Tuberculosis

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