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DOI: 10.1055/s-0043-1768148
Images in GI Infection: Pseudo-Appendix-like Appearance of Post-Tubercular Gastrointestinal Stricture
Funding None.
A 20-year-old female presented with recurrent episodes of abdominal pain. She had previously received antitubercular therapy for a diagnosis of gastrointestinal tuberculosis on the basis of abdominal lymph node cytology showing granuloma with acid-fast bacilli. She underwent a colonoscopy for suspected post-tubercular intestinal stricture. Just beyond the hepatic flexure, an appendix-like structure was identified ([Fig. 1A] and [B]). However, because of nonvisualization ileocecal valve and intubation of the terminal ileum, we applied suction, which showed a flow of fluid (bowel preparation) from this opening. A wire-guided controlled radial expansion balloon was passed across this narrowing completely (CRE, Microvasive, Boston Scientific Co., Natick, MA, United States), and dilatation was performed up to 12 mm diameter for 30 seconds. The colonoscopy was not negotiated across post-dilatation ([Fig. 1C] and [D]). The patient became asymptomatic after a single dilatation procedure and was advised to follow up.
The case has two important lessons. The identification of the cecum on colonoscopy is usually based on the visualization of one of two structures: the appendix or the intubation of the terminal ileum.[1] Cecum may also be identified by the tri-radiate folds formed by the fusion of the three tenia coli around the appendix. However, here, the stricture had the appearance of a normal appendix, and only because of strong suspicion, was the stricture suspected. Even transillumination may not correctly identify the cecum in such patients because of pulling up and contraction. Secondly, tubercular involvement of the ileocecal area can result in strictures, which can present even after the completion of therapy and healing of ileal ulcers.[2] Therefore, continuing symptoms even after antitubercular therapy may suggest the presence of sequelae such as strictures.[3]
Informed Consent
Informed consent was obtained from the patient.
Ethical Statement
Not applicable.
Authors' Contribution
All authors contributed equally to the article.
Data Availability
There are no additional data associated with this work.
Publication History
Received: 29 December 2022
Accepted: 20 January 2023
Article published online:
12 October 2023
© 2023. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Cotton PB, Willaims CB. Cotton and Williams' Practical Gastrointestinal Endoscopy: The Fundamentals. Jan 2003, Hoboken, New Jersey, U.S Blackwell Publishing; 5th ed..
- 2 Sharma V, Mandavdhare HS, Dutta U. Letter: mucosal response in discriminating intestinal tuberculosis from Crohn's disease-when to look for it?. Aliment Pharmacol Ther 2018; 47 (06) 859-860
- 3 Kumar P, Jena A, Birda CL. et al. Safety and efficacy of non-fluoroscopic endoscopic dilatation of gastrointestinal tuberculosis related strictures. BMC Gastroenterol 2022; 22 (01) 60