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_?


Previous Grand Rounds View All

D
Duodenal and Jejunal Polyps in Extra-hepatic Portal Hypertension
Ira Shah
A 7 years old boy suffering from extrahepatic portal hypertension had an episode of malena. An upper GI endoscopy was done. There was presence of Grade 1-2 esophageal varices without any bleeding stig....
H
Hodgkin’s Lymphoma with Tuberculosis
Ira Shah
A 12 years old boy presented with evening rise of fever for 4-5 months, bilateral otorrhoea for 1 month and loss of appetite. He was treated for cervical tuberculous lymphadenopathy 3 years ago and to....
S
Splenectomy without Prior Vaccination
Ira Shah
A 9 years old boy presented with pain in left part of abdomen since days. There was no fever or trauma. On examination, vital parameters were normal. There was firm splenomegaly. Other systems were no....
D
Demyelination in tuberculous meningitis
Ira Shah
A 7 years old girl presented with fever for 15 days, and 1 episode of generalised tonic clonic convulsion followed by loss of consciousness. Her sister was suffering from fibrocavitatory TB and was on....
F
Fever, jaundice with emerging pancytopenia
Ira Shah
A 7 year old boy born of non-consanguineous marriage presented with fever with chills for 10 days. He had left flank pain and bilateral painful knees along with fever. There was one episode of uprolli....
CIP 2017
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.