Endoscopic diagnosis and clinical experience of colonic tuberculosis

: From February 1979 to May 1994, 18 cases of colonic tuberculosis were detected by colonscopy at Chang Gung Momorial Hospital, Linkou Medical Center. There were 10 males and 8 females, with mean age of 43.6. In ten, the diagnosis was confirmed histologically or bacteriologically in colonic biopsy material and post-operated lymph nodes. The remaining 8 patients was suspected on colonoscopy, and had good response to antituberculous therapy. The major symptoms were abdominal pain (83%), diarrhea (67%), and body weight loss (61%). Average duration from symptoms to diagnosis was 4.1 months. Chest X-ray revealed active pulmonary tuberculosis in 14 of 18 patients (78%), 4 of 14 patients were military type. The colonic tuberculosis involved in ileocecal area in 6, ileocecum and contiguous colonic regions in 7, segmental colonic involvement in 4, and pancolitis in 1 patient. Multiple ulceration and ulcerohypertrophic lesions were the major colonoscopic findings. Typical caseating granuloma were found in 5 cases (36%) from colonoscopic biopsy, the other 5 from surgical resected specimens. Antituberculous therapy produced remarkable symptomatic improvement in all patients except 2 cases complicated with intestinal obstruction necessitating laparotomy. Colonoscopy with biopsy is a useful diagnostic tool in early diagnosis and avoiding unnecessary laparotomy in colonic tuberculosis.