Everyone has heard of tuberculosis, most often heard of tuberculosis of the lungs. Today we will learn about tuberculosis of the intestines – intestinal tuberculosis. Similar to pulmonary tuberculosis, intestinal tuberculosis is a chronic, specific infection caused by Mycobacterium tuberculosis invading the intestinal tract. Etiology Primary intestinal tuberculosis infection is mainly due to the use of milk contaminated with Mycobacterium tuberculosis, and its incidence has been very low since the use of sterilized milk. Currently, secondary intestinal tuberculosis is the most common clinical cause, and the pathogenic bacteria are mostly human tubercle bacilli. Mycobacterium tuberculosis spreads to the intestines through the gastrointestinal tract, blood, or directly from adjacent lesions, and pulmonary tuberculosis is the most common route of infection. Pathology 85% of the combined lesions occur in the ileum. Mycobacteria from the intestinal tract pass through the intestinal mucosal epithelium into the mucosal glands, where they hide in the deeper layers causing inflammation and enter the Peyer lymph nodes and lymphoid tissue via phagocytosis. The ileocecal region is rich in lymphoid tissue, so there are many lesions. Clinical manifestations Intestinal tuberculosis may be part of systemic tuberculosis or combined with pulmonary tuberculosis. Therefore, systemic symptoms of tuberculosis such as low-grade fever, night sweats, fatigue, lethargy and loss of appetite are common. Abdominal symptoms vary with the type of lesion. 1.Micro ulcer type Abdominal pain is vague, occasionally with paroxysmal colic, located around the umbilicus or in the middle and upper abdomen. It is often aggravated after eating and relieved after defecation. Most of them are accompanied by changes in bowel habit, diarrhea is more common, in the form of watery diarrhea, fecal occult blood test may be positive, but there are few bloody stools with naked eyes. In a few patients, constipation is predominant. After the lesion lasts for a period of time, the lesion tends to heal and there is scar formation, there may be incomplete intestinal obstruction symptoms appear, paroxysmal abdominal colic is more intense than before, accompanied by intestinal pattern, intestinal sound hyperpronunciation, and other manifestations of partial intestinal obstruction. If there is perforation, abdominal abscess or extra-intestinal fistula will appear. 2.Proliferative type The lesions develop slowly and have a long course. At the beginning, there is vague pain in the abdomen, and then it turns into paroxysmal colic with vomiting due to incomplete intestinal obstruction. There are intestinal patterns and hyperactive bowel sounds in the abdomen, and a fixed, hard mass with tenderness can often be palpated in the right lower abdomen. Laboratory tests may show anemia and increased blood sedimentation. Chest X-ray shows active or old tuberculosis foci in the lungs, but in proliferative intestinal tuberculosis is not necessarily accompanied by pulmonary tuberculosis. Barium gastrointestinal radiography shows accelerated motility of the small intestine, agitation of the ileocecal region, which is not easy to fill resulting in barium residue, and sometimes persistent intestinal spasms are seen. Sometimes, the upper and lower intestinal segments of the lesion are well filled, and a jumping sign (Stierlin’s sign) appears. In multiple scattered lesions, segmental dilatation of the bowel may occur. After barium evacuation, there is segmentation of the small intestine with snowflake-like distribution. In proliferative intestinal tuberculosis, proliferative strictures and malformations or filling defects are seen in the ileocecal portion and the proximal portion of the ascending colon, with disorganized mucosal folds, rigidity of the intestinal wall, and loss of colonic pouching. Diagnosis The diagnosis of intestinal tuberculosis must have one of the following conditions: 1, lesions found during surgery, mesenteric lymph node biopsy confirmed tuberculous lesions; 2, lesions of tissue pathology confirmed tuberculous nodules and caseous changes; 3, lesions of the tissue to find tuberculosis mycobacteria; 4, lesions of the tissue through the bacterial culture or animal inoculation confirmed that there is tuberculosis growth. Treatment Intestinal tuberculosis should be treated mainly with internal medicine, and surgical treatment should be considered only when accompanied by surgical complications. The perioperative management of patients focuses on: 1) controlling the activity of tuberculous lesions; 2) improving the nutritional status of patients. The indications for surgery for intestinal tuberculosis are: 1, perforation of the lesion to form a limited abscess or intestinal fistula; 2, ulcerative lesions with scar formation or proliferative lesions leading to intestinal obstruction; 3, free perforation of the lesion combined with acute peritonitis.