ISOLATED SIGMOID TUBERCULOSIS - REPORT OF A CASE

PURPOSE: To heighten awareness of colonic tuberculosis (TB) as a once rare disease that is undergoing a resurgence in the United States. MET HODS: Report of a case of isolated sigmoid tuberculosis with a brief l iterature review of the topic. RESULTS: TB can no longer be considered a rare disease in the United States because, in part, of the acquired immunodeficiency syndrome epidemic and because, in part, of increased immigration and lack of containment. The signs and symptoms of coloni c TB are nonspecific; therefore, a high index of suspicion must be mai ntained. Only 20 percent of patients will have associated active pulmo nary TB. Colonoscopy with multiple biopsies at ulcer margins should be performed for diagnosis. Tissue should be sent for routine histology and culture and smeared for direct visualization of acid-fast bacilli. If colonic TB is suspected, empiric treatment is warranted, despite n egative histology, smear, and culture results. Patients will usually s how a dramatic response in one to two weeks. Treatment is solely medic al, and all patients should receive a full course of antituberculous c hemotherapy. Exploratory laparotomy is necessary if diagnosis is in do ubt, when there is concern about a neoplasm, or for complications incl uding perforation, obstruction, hemorrhage, or fistulization. CONCLUSI ON: An increased awareness of intestinal TB coupled with familiarity o f the pathophysiology, diagnostic methods, and treatment should increa se the number of cases correctly diagnosed preoperatively and, therefo re, improve the outcome of patients with this disease.