Grand Rounds

Multiple ulcers in the terminal ileum

Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital and Incharge Pediatric HIV, TB and Liver Clinics, B J Wadia Hospital for Children, Mumbai, India.

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem:
A 16 years old boy presented with abdominal pain and intermittent low grade fever for 3-4 months. An ultrasound {USG} abdomen showed multiple lymphnodes with bowel wall thickening of ascending colon, caecum, terminal ileum and appendix. There were no altered bowel habits on history. CT abdomen showed circumferential mural thickening involving distal ileum, caecum, proximal ascending colon with mesenteric non-necrotic lymphnodes {2.1 x 1.3 cm largest node}. Ileocolonoscopy showed ulcers in terminal ileum with granulation on gross appearance. Histopathological examination revealed non-specific inflammatory ulcers with no caseous necrosis or tuberculosis {TB}. He was advised intestinal resection of the diseased segment by the treating surgeon and so he presented to us for a second opinion. He had already been started on antituberculous therapy {ATT} for past 20 days. On presentation to us, his weight was 39.8 kg. He had pain and tenderness in right iliac fossa. Other systems were normal. Mantoux test was negative. Hemogram and ESR were normal. He had not been exposed to non-steroidal anti-inflammatory drugs {NSAIDS}.

What is the cause of ulcers in the small intestine_? Is it really TB_?

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CIP 2017
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