Ileocecal Tuberculosis - Radiographic Features and Treatment

Introduction:

Ileocecal tuberculosis is the most common type affecting the gastrointestinal tract and the third most common type of extrapulmonary tuberculosis. There are three types of ileocecal tuberculosis morphologically named ulcerative, hypertrophic, and ulcer hypertrophic.

• Ulcerative Ileocecal Tuberculosis: It is a usual type of tuberculosis secondary to pulmonary tuberculosis. The symptoms include fever, dyspepsia, vomiting, abdominal pain, and weight loss.

• Hypertrophic Ileocecal Tuberculosis is the type of tuberculosis in which there is an overgrowth of the lining of the gastrointestinal tract due to infection.

• Ulcer Hypertrophic Tuberculosis.

What Is Tuberculosis?

Tuberculosis is a severe infectious disease that affects the lungs. It also affects the gastrointestinal tract. Symptoms of tuberculosis depend on the type of infection, whether latent tuberculosis or active tuberculosis.

1) Latent Tuberculosis: In cases of latent infection, the body has no symptoms. If the treatment is not started, latent tuberculosis turns into active tuberculosis. It is also known as inactive tuberculosis.

2) Active Tuberculosis: It is a form of tuberculosis in which symptoms are seen in the body. The symptoms include:

1. Coughing for three weeks or more.

2. Coughing with blood and mucous.

3. Unintentional weight loss due to loss of appetite.

4. Fatigue.

5. Fever.

6. Chills.

7. Sweating at night.

8. Loss of appetite.

The causes of tuberculosis include infection bacteria from one person to another through tiny microscopic droplets released from the air. It happens when a person affected by tuberculosis comes in contact with an uninfected person.

What Are the Risk Factors for Tuberculosis?

A healthy immune system successfully fights tuberculosis bacteria, but some conditions may make the body prone to infection.

These include:

• Diabetes: Increase in blood glucose levels due to abnormal insulin secretion by the pancreas.

• HIV: Human immunosuppressant virus affects all parts of the body and primarily the immune system. It reduces the potential of the body to fight infections and diseases.

• Severe Kidney Diseases: Some kidney diseases, such as inflammation and infection, reduce the body's immunity and make it prone to infections.

• Certain cancers make the body weak and prone to infections like tuberculosis.

• Treatment of chemotherapy for cancer also makes the body weak and prone to some infections.

• Drugs are administered to prevent the rejection of transplanted organs. These drugs are immunosuppressants to prevent the body's reaction to the transplanted organ. However, this suppressant immunity may lead to infections such as tuberculosis.

• Some drugs used to treat infections, such as rheumatoid arthritis, psoriasis, and Crohn’s disease, can lead to tuberculosis.

• Low body weight or malnutrition.

• Either young aged or older aged individuals.

What Are the Radiographic Features of Ileocecal Tuberculosis?

1) Ultrasound: The ultrasound of ileocecal tuberculosis may show a thickening of the caecal wall and lymphadenopathy (swollen lymph nodes).

2) Fluoroscopy: Fluoroscopy is a technique in which a real-time video is captured inside the body by passing the X-rays through it over time.

3) Barium Study: It shows different features in the infection's acute or subacute and chronic stages.

• Chronic Stage of Infection: In these cases, the ileocaecal valve appears to be fixed, incompetent, and rigid. The caecum seems to be conical and shrunken in size. The caecum gets pulled up due to fibrotic changes in the mesocolon.

• Acute or Subacute Stage: The Fleischner sign is visible in this imaging technique. It shows thickening and gaping of the ileocaecal valve and narrowing of the terminal ileum. Barium study also shows hypermotility and thickening of the caecum.

4) Computed Tomography: The X-rays show asymmetric thickening of the ileocecal valve and mesenteric lymphadenopathy with central low attenuation areas. The computed tomography also shows circumferential wall thickening of the terminal portion of the ileum and caecum. Due to prolonged infection, tuberculosis also affects other organs (like the lungs).

Which Diseases Show Similar Imaging Features as Ileocecal Tuberculosis?

• Colorectal Carcinoma is also known as caecal carcinoma, which also shows eccentric cecal wall thickening and metastasis.

• Small Bowel Lymphoma: The thickness of the bowel increases by 2 cm (centimeter) with a lack of structuring. There is also lymphadenopathy which may be present with or without hepatomegaly.

• Crohn’s Disease: It shows illegal terminal involvement more than tuberculosis. There might be the presence of some ascites. There is also vascular engorgement and fibrofatty proliferation of mesentery.

• Amoebic Colitis: It is infectious colitis that is caused due to the trophozoite form of protozoa Entamoeba histolytica. In most cases, the cyst form stays in the colon, and the patient is asymptomatic.

What Is the Treatment of Ileocecal Tuberculosis?

1) In cases of latent tuberculosis, the treatment is through medications such as antibiotics, which help prevent the conversion of active tuberculosis. Some of the drugs which are used to treat tuberculosis are:

• Ethambutol

• Pyrazinamide

• Rifampin

• Isoniazid

2) In cases of drug-resistant tuberculosis, the treatment is done with a combination of antibiotics and injectable medications such as Amikacin or Capreomycin, which is used for twenty or thirty months.

What Are the Side Effects of Tuberculosis Medicines?

The side effects of drugs used to treat tuberculosis are not very serious and rarely occur. However, the side effects may include:

1. Loss of appetite.

2. Dark urine.

3. Nausea or vomiting.

4. Jaundice causes yellowish discoloration of the skin.

5. Blurred vision.

6. Easy bruising or bleeding.

Conclusion:

Ileocecal tuberculosis is the most common type of tuberculosis affecting the gastrointestinal tract. The symptoms include thickening of the caecal wall leading to inflammation and infection. Tuberculosis can be either latent or inactive. Therefore, treating latent or inactive tuberculosis is vital or may turn into an active form. The treatment includes a combination of drugs, such as antibiotics.