It is a chronic infection caused by Mycobacterium tuberculosis invading the intestine. The majority of cases are secondary to extraintestinal tuberculosis, especially open pulmonary tuberculosis. The age of onset is mostly young adults, with slightly more women than men. Zeng Yi, Department of Respiratory Medicine, Nanjing Chest Hospital Etiology Intestinal tuberculosis is usually caused by human tuberculosis bacilli, but occasionally bovine tuberculosis may develop from drinking bacteriophage milk or dairy products. 2. Blood-borne transmission. Blood-borne transmission is also one of the ways of infection of intestinal tuberculosis. It is seen in the invasion of the intestinal tract by hematogenous spread of the cornified tuberculosis pathway. 3, adjacent tuberculosis foci, intestinal tuberculosis can also be caused by the direct spread of intra-abdominal tuberculosis foci, such as tuberculosis of the fallopian tubes, tuberculous peritonitis, mesenteric lymphatic tuberculosis, etc.. This infection is spread through the lymphatic vessels. Symptoms Most of them have a slow onset and long course. Typical clinical manifestations are summarized as follows: 1. abdominal pain, because the lesion often involves the ileocecal region, so the pain is most commonly found in the right lower abdomen, and limited pressure points can be found on palpation. The pain can also be located around the umbilicus. The pain is generally mild, vague or dull, or intermittent, often triggered during or after meals. When proliferative intestinal tuberculosis is complicated by intestinal obstruction, the abdominal pain is mainly colic, and there are corresponding symptoms of intestinal obstruction. 2, diarrhea and constipation, diarrhea is one of the main symptoms of ulcerative intestinal tuberculosis, which is caused by inflammation and ulcer stimulation of the intestinal flexure, accelerated intestinal peristalsis, rapid evacuation and secondary malabsorption. The bowel movements are usually 2-4 times a day, mostly pasty stools, containing only a small amount of mucus in mild cases, but in severe cases the diarrhea can be up to 10 times a day, with mucus and pus in the stool, and blood in the stool is less common. In addition, there can also be constipation, stool in the form of sheep feces, or diarrhea and constipation alternately. 3. Abdominal masses are mainly seen in hyperplastic intestinal tuberculosis, where the intestinal wall thickens locally to form a mass. When ulcerative intestinal tuberculosis and surrounding tissues are adherent, or when mesenteric lymphatic tuberculosis is present, a mass can be formed and can be felt. The mass is usually located in the right lower abdomen, moderately hard, and may have light pressure pain. 4, systemic symptoms, ulcerative intestinal tuberculosis often have tuberculosis toxemia, such as afternoon hypothermia, irregular fever, flaccid fever or fever, accompanied by night sweats, may have weakness, wasting, anemia dystrophic edema and other symptoms and signs, and can have extra-intestinal tuberculosis, especially tuberculous peritonitis, pulmonary tuberculosis and other related manifestations, proliferative intestinal tuberculosis without tuberculosis symptoms, longer duration of disease, better general condition. Blood picture and blood sedimentation, total white blood cell count is generally normal, red blood cell and hemoglobin are often low, with mild to moderate anemia, which is more common in patients with ulcerative type. In patients with active lesions, blood sedimentation is often increased. 2.Fecal examination, fecal concentration to find tuberculosis bacteria, only when the sputum bacteria negative, it is meaningful. 3, X-ray examination, X-ray barium meal angiography or barium enema examination is important for the diagnosis of intestinal tuberculosis. 4.Fiber colonoscopy can directly observe the lesions in the whole colon, cecum and ileocecal region, and biopsy or sampling for bacterial culture is feasible. Treatment The treatment of intestinal tuberculosis, like pulmonary tuberculosis, should emphasize early, combined, appropriate dosage and full course of medication. 1. Rest and nutrition Reasonable rest and nutrition should be the basis of treatment of tuberculosis. Active intestinal tuberculosis should emphasize bed rest, reduce caloric consumption, improve nutrition and increase the body’s ability to resist disease. 2.Anti-tuberculosis drug treatment Anti-tuberculosis drug selection and usage are detailed in pulmonary tuberculosis. (1) Long course method This is the standard treatment, using isoniazid and streptomycin or a combination of three drugs with para-aminosalicylic acid. It takes 12-18 months for the whole course. (2) Short course method The course of treatment is shortened to 6-9 months, and its efficacy and recurrence rate are as satisfactory as those of the long course method. Generally, the combination of isoniazid and rifampicin is used. For severe intestinal tuberculosis or those with severe extra-intestinal tuberculosis, the combination of streptomycin or pyrazinamide or ethambutol is recommended. This short course method needs to pay attention to the damage of the drug to the liver. Rifampicin can be used instead of rifampicin, 150mg daily, which seems to be less toxic than rifampicin. 3, symptomatic management and surgical treatment abdominal pain can be used belladonna, atropine or other anticholinergic drugs. Incomplete intestinal obstruction sometimes requires gastrointestinal decompression, and correction of water and electrolyte disorders. If there are signs of anemia and vitamin deficiency, symptomatic medication is used. Surgical treatment is mainly limited to those with complete intestinal obstruction or partial intestinal obstruction that does not improve with medical treatment, those with acute intestinal perforation causing fecal fistula that does not improve with conservative treatment, and those with massive intestinal bleeding that fails to stop after active resuscitation. Intestinal tuberculosis is often secondary to pulmonary tuberculosis, so the diagnosis of the original disease should be made, active treatment, strengthening public health publicity, educating patients to avoid swallowing sputum and not spitting, and milk should be adequately sterilized.