Tuberculous involvement of the intestine is most likely a consequence of swallowing infected sputum. Disease in the Ileocaecal area is the most typical.
Ulcerative lesions are the commonest form, but hypertrophic and ulcero-hypertrophic forms also occur.
Important differential diagnoses are Crohn's disease, yersinia enterocolitis, actinomycosis, carcinoma, amoebiasis or ulcerative colitis.
Tuberculous enteritis (Case 2785)
The patient was a 50 year old woman who presented with a history of abdominal pain and dysentery of some months duration. Her chest X-Ray showed a possible tuberculous lesion in the left apex.
Laparotomy was performed, and 90cm of her bowel was resected (distal ileum, caecum and ascending colon).
The typical transverse ulcers of tuberculous enteritis can be seen, with ragged bases.
The transverse orientation of the ulcers is related to the direction in which the lymphatic vessels run in the wall of the ileum and along which the infection tends to spread.
Here the distal three areas of ulceration are associated with fibrous thickening of the wall with consequent strictures.
When the bottle is reversed it can be seen that the serosa overlying these ulcers contains numerous tuberculous foci.