COMPLICATED INTESTINAL TUBERCULOSIS OF TH E MESENTERIC ROOT

History and clinical findings: In the course of 2 1/2 years a 72-year- old man had five episodes of intestinal bleeding with anaemia, but no cause was at first found by routine diagnostic tests. After the fourth episode a diagnostic laparotomy was performed at which a diffusely in filtrating growing tumour was found. As it encircled the mesenteric va scular axis resection was not possible. But because of threatened ilea l obstruction by the tumour a segmental ileal resection was performed, but no intraoperative diagnosis could be established. Investigations: Repeated oesophago-gastro-duodenoscopies and a coloscopy all revealed blood, especially in the upper gastrointestinal tract, but no bleedin g source was found. Angiography suggested bleeding in the terminal ile um. Computed tromography demonstrated a tumour in the region of the me senteric root. Diagnosis, treatment and course: At a second laparotomy because of another bleeding, which required a blood transfusion, tube rculosis was diagnosed. Triple drug treatment was initiated and the pa tient has been free of symptoms and bleedings since then and fully act ive for 1 1/2 years. Conclusion: This case clearly demonstrates the di fficulty of diagnosis and the long delay until specific treatment, bec ause the combination of >>tumour<<, bleeding and stenosis of the small intestine by an infiltrative lesion at first pointed to malignant pro cess.