DIAGNOSIS AND OUTCOME OF ISOLATED RECTAL TUBERCULOSIS

PURPOSE: Segmental colonic tuberculosis commonly involves the ascendin g, transverse, or sigmoid colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. This study describes the clinical presentation, endoscopic features, and outcome of isolated rectal tube rculosis. METHODS: Isolated rectal tuberculosis was defined as focal l esions of the rectum in the absence of radiologically demonstrable les ions in the small and large bowel on barium contrast studies. Diagnosi s of rectal tuberculosis was based on characteristic endoscopic appear ance of lesions, histopathologic features of tuberculosis in biopsy/re sected material, and response to antitubercular therapy. RESULTS: Eigh t patients with rectal tuberculosis were seen during a four-year perio d at our hospital. Hematochezia was the most common presenting feature (88 percent), followed by constitutional symptoms (75 percent) and co nstipation (37 percent). Rectal examination revealed a tight stricture within 10 cm of the anal verge in seven patients. Barium enema showed stricture of variable length, with focal areas of deep mucosal ulcera tion and increase in presacral space. Proctoscopic findings were tight stricture (7), nodularity with ulceration (6), and multiple aphthous ulcers (1). Granulomatous infiltration was detected in seven of eight patients in biopsy material obtained at endoscopy (6) or surgery (1). Cessation of hematochezia, resolution of constitutional symptoms, and weight gain were seen in all patients following treatment with antitub ercular drugs. CONCLUSION: Our data suggest that tubercular involvemen t of rectum, although uncommon, is an important cause of rectal strict ures in India. Response to antitubercular chemotherapy is uniformly go od, and surgery is seldom required in these patients.