A rare case of coexistent carcinoma of the colon with tuberculosis
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Hellenic Journal of Surgery (2016) 88:5, 360-363
A Rare Case of Coexistent Carcinoma of the Colon with Tuberculosis Devadatta Poddar, Prashant Kumar Singh, Gaurav Patel, Rohit Gohil
Abstract This is a case report of a 35-year-old female who presented with acute intestinal obstruction initially diagnosed as ileocaecal tuberculosis. She was submitted to exploratory laparotomy with a right hemicolectomy for a non-passable ileocaecal mass. Histopathology showed colon cancer with tuberculosis both in the colon as well as the mesenteric lymph node. In addition to its pathological rarity, this case is of particular interest, because it highlights the diagnostic dilemma and therapeutic challenge associated with such a condition. Key words: Colon cancer; tuberculosis; intestinal ostruction
Introduction Tuberculosis is a global health problem affecting nearly one-third of the world's population. Abdominal tuberculosis is a common entity but involvement of the colon is unusual. Most common colon cancers are adenocarcinomas that mostly involve the right colon. Coexistence of abdominal tuberculosis and colon carcinoma is a rare entity, with just nearly 70 cases reported to date over a span of 200 years. No firm evidence of association between tuberculosis and carcinoma colon has been shown. We present a case of carcinoma of the colon coexistent with tuberculosis.
Organ function test and coagulation studies were normal. Abdominal radiography revealed dilated bowel loops with multiple air fluid levels. Ultrasonography of the abdomen showed dilated bowel loops with interbowel fluid. CECT of the abdomen disclosed irregular ileocaecal wall thickening, proximal bowel dilatation with air fluid levels and marginally enlarged mesenteric lymph nodes suggestive of ileocaecal tuberculosis with small bowel obstruction. A working diagnosis of Koch's abdomen with acute intestinal obstruction was made. The patient was initially managed
Case Presentation A 35-year-old female with a known case of Koch’s abdomen who had been on anti-tubercular therapy (2+4) for two weeks, presented to the emergency department complaining of abdominal, obstipation, abdominal distension and vomiting. Physical examination revealed tachycardia and dehydration. The abdomen was found to be distended, tender, with rebound tenderness present in the right iliac fossa (RIF), and without signs of palpable abdominal mass/organomegaly. Bowel sounds were exaggerated, and per rectal examination was unremarkable. Laboratory tests showed ESR:100, Hb:10.6, leucocyte count: 10500 with relative lymphocytosis, QuantiFERON-TB Gold:11.72 IU/ml (normal
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