Duodenal tuberculosis
Introduction
Introduction to duodenal tuberculosis Duodenal tuberculosis is a relatively rare disease. Duodenal obstruction is the most common type of duodenal tuberculosis, mainly showing abdominal pain and vomiting. Mostly after eating, there is a feeling of fullness or pain in the upper abdomen, nausea, vomiting, and pain in the upper abdomen or a feeling of fullness after vomiting. The disease can be diagnosed by pathological examination after surgery. Due to the short residence time of food in the duodenum and the role of gastric acid, tubercle bacilli generally do not grow and reproduce in the duodenum, but when the patient has low resistance and is exposed to a large number of tubercle bacilli, foreign reports 10% to 50 % of patients with active tuberculosis may develop an infection. basic knowledge The proportion of the disease: the probability of the population is 0.096% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction peritonitis intussusception
Cause
Cause of duodenal tuberculosis
(1) Causes of the disease
Due to the short residence time of food in the duodenum and the role of gastric acid, tubercle bacilli generally do not grow and reproduce in the duodenum, but when the patient has low resistance and is exposed to a large number of tubercle bacilli, foreign reports 10% to 50 % of patients with active tuberculosis may have an infection, the reasons for which are related to the following factors:
1. Tuberculosis circulates through the blood or lymph to the submucosa or muscle layer of the duodenal wall to produce tuberculosis, which in turn invades the mucosa and serosal layer.
2. Tuberculosis adjacent to the tissue or organ directly invades and penetrates the duodenal wall.
3. Mycobacterium tuberculosis is mixed in the sputum ingested or swallowed. Mycobacterium tuberculosis stays in the duodenum, invading the mucosa and submucosa, causing infection. In addition, due to the abundant blood flow in the duodenum, it is also infected with Mycobacterium tuberculosis. Created conditions.
4. The biliary system may also be another route of infection. For example, tuberculosis of liver tuberculosis can cause infection through the extrahepatic bile duct to the duodenum.
The predilection of duodenal tuberculosis is mainly in the level of the duodenum, followed by the descending part, and the tuberculosis of the duodenum often invades the stomach.
(two) pathogenesis
Duodenal tuberculosis is the same as other gastrointestinal tuberculosis. The lesions often occur in the submucosal tissue. The mucosa invades the mucosa and forms ulcers of different sizes and depths. A few are polypoid or large nodular masses. Caseous necrosis and typical tuberculous granuloma, the pathology can be mainly divided into 3 types:
1. Inflammatory hyperplasia type duodenal mucosa is polypoid-like hyperplasia, with shallow ulcer formation, fibrous tissue hyperplasia and scar contraction around, due to the fusion of swollen lymph nodes near the lesion, often leading to duodenal failure Complete obstruction, or even complete obstruction.
2. Ulcer-type lesions usually occur in the submucosal layer, and the ulcers form after the invasion and mucosal surface ulceration. Generally, the muscle layer is not involved, and there are often enlarged lymph nodes around the lesion.
3. Ulcer hyperplasia ulcers are large and have fibrous tissue hyperplasia with scar formation.
Prevention
Duodenal tuberculosis prevention
Preventive work is the fundamental way to prevent and treat tuberculosis, and focuses on the discovery of extraintestinal tuberculosis, especially the early diagnosis of tuberculosis and active anti-tuberculosis treatment, as soon as possible to make the bacteria turn negative, so as not to swallow the bacteria-containing sputum and cause the intestines Infection, we must emphasize the health promotion and education of tuberculosis. We must educate patients not to swallow sputum. We should keep the bowel movements unobstructed. We must strengthen hygiene supervision and promote the use of public chopsticks to eat. Milk should be sterilized.
Complication
Duodenal tuberculosis complications Complications, intestinal obstruction, peritonitis, intussusception
In the process of chronic evolution of intestinal tuberculosis, various complications can occur.
Intestinal obstruction
Is the most common complication of this disease, mainly in proliferative intestinal tuberculosis, ulcerated intestinal tuberculosis due to adjacent peritoneal adhesions caused by intestinal traction, restraint and compression, or due to intestinal ulcer healing, scar contraction, can make the intestinal lumen Stenosis causes obstruction, and obstruction is mostly chronic progressive, often partial, varying degrees of severity, prolonged prolongation, can seriously affect the nutritional status of patients, and a few can develop complete intestinal obstruction.
2. Bowel perforation
The incidence is second to intestinal obstruction, ranking second, mainly for subacute or chronic perforation, which can form abscess in the abdominal cavity, and form intestinal fistula after ulceration. Acute perforation is rare, often occurs in the intestine with extremely dilated proximal end of the obstruction. Qu, or seen in multiple intestinal stenosis caused by obstructive intestinal obstruction, although ulcerative intestinal tuberculosis has adhesions around the intestinal tract, ulcers generally do not break into the free abdominal cavity, but when the disease develops rapidly, the body response is poor, the ulcer can Deep penetration, causing acute perforation.
3. Other
There are peritonitis, intestinal adhesions, intussusception and contractile diverticulum.
Symptom
Duodenal tuberculosis symptoms Common symptoms Night sweats Abdominal tenderness Upper abdominal pain Lymph node enlargement No active tuberculosis Lesions Low fever Abdominal pain Upper gastrointestinal bleeding Upper abdominal discomfort Disgusting
Duodenal tuberculosis lacks unique clinical manifestations. This disease is more common in young adults. It occurs in 20 to 40 years old, especially in female patients. It is mainly caused by oral infection, insidious onset, slow progress, long course of disease, early symptoms. Not obvious, the clinical manifestations are as follows:
1. The symptoms of duodenal obstruction are the most common duodenal tuberculosis, mainly showing abdominal pain and vomiting. Most of them have a feeling of fullness or pain in the upper abdomen after eating, nausea, vomiting, upper abdominal pain or feeling of fullness after vomiting. Alleviate, Gupta et al reported 30 cases of duodenal tuberculosis, of which 22 cases showed gastroduodenal obstruction; Cao Tao et al reported 16 cases, showing 13 cases of gastroduodenal obstruction.
2. Symptoms of dyspepsia are manifested as upper abdominal discomfort, abdominal distension, nausea, and treatment with antacids.
3. Tuberculosis symptoms Some patients may have low fever, night sweats, fatigue, anorexia and weight loss.
4. Other symptoms A small number of patients may have upper gastrointestinal bleeding as the first manifestation, and some patients may have internal hemorrhoids between adjacent tissues or organs such as the renal pelvis and bile duct.
5. The signs of duodenal tuberculosis mainly include upper abdominal tenderness, right upper quadrant mass, positive water vibration, superficial lymph node enlargement.
Examine
Duodenal tuberculosis examination
When the systemic condition of patients with duodenal tuberculosis is better, there is no abnormality in laboratory tests. When the course of disease is long, there may be an increase in erythrocyte sedimentation rate and a decrease in hemoglobin. The main laboratory test is positive, and the tuberculin test may be positive. Tuberculosis antibodies are positive, and occult blood can be positive when combined with bleeding.
1.X-ray performance
For patients with suspected duodenal tuberculosis, upper gastrointestinal barium meal examination is required. In patients with proliferative duodenal tuberculosis, common X-ray findings are different degrees of luminal stenosis, mostly extraluminal lymph node compression. As a result, the latter can cause a "knife-cut" sign in the obstruction site, or the duodenal ring enlarges, showing a similar superior mesenteric artery compression syndrome, obstruction of the proximal intestinal dilatation, a small number of patients with intraluminal stenosis, mucosal folds and polyps Changes in the shape, ulcer patients may have a ball or a posterior ulcer, ulcers are small, not easy to show, but more with duodenal mucosal folds thickening, stenosis and stenosis.
2. Abdominal ultrasound and CT examination
Upper abdominal masses can be found in patients with more severe conditions, especially those with enlarged lymph nodes near the duodenal cavity.
3. Endoscopy
(1) gastroscopy: visible stenosis, endoscopic difficulty, narrow part of the mucosal congestion and edema, some patients may have erosion and ulcer formation, narrow proximal intestinal lumen dilatation, due to tuberculous granuloma located in the submucosa, plus the lumen Stenosis makes endoscopic biopsy difficult, and biopsy results are mostly non-specific inflammatory manifestations. Therefore, endoscopy is not meaningful for diagnosis except for clear obstruction.
(2) Laparoscopy: The lesion can be directly observed, and the suspicious lesions are biopsied to avoid laparotomy, so it has certain value for diagnosis.
Diagnosis
Diagnosis and identification of duodenal tuberculosis
Diagnosis needs to be combined with clinical symptoms, laboratory examinations and imaging findings. However, due to the lack of characteristic features of the disease, imaging examination can only determine the location of obstruction. Therefore, the current diagnosis requires laparotomy to detect enlarged lymph nodes. Biopsy to confirm the diagnosis.
Differential diagnosis
1. Duodenal ampullary ulcer has ulcer symptoms, such as fasting pain, acid reflux and heartburn, and easy to combine upper gastrointestinal bleeding, antacid treatment is effective, gastroscopy or duodenoscopy can be identified.
2. Duodenal cancer is more common in patients over 50 years old, the condition often worsens within a few months, can show anemia, hematemesis, jaundice and weight loss, endoscopic biopsy found that cancer cells can be diagnosed, such as biopsy not found See cancer cells, clinical symptoms can not be differentiated from duodenal tuberculosis, you need to dynamically observe changes in the condition, while looking for the presence of other areas of tuberculosis, such as tuberculosis, if any, it suggests the diagnosis of duodenal tuberculosis.
3. Pancreatic cancer can also show upper abdominal mass. When the pancreatic head and pancreatic body cancer compress the duodenum, it can also cause intestinal stenosis, obstruction and mucosal destruction, but the patient has jaundice and progressive aggravation. Ultrasound and abdominal CT examination, combined with ERCP and MRCP examination, can be identified.
