Overview Intestinal tuberculosis is a relatively common form of extrapulmonary tuberculosis, a chronic infection caused by invasion of the intestinal tract by Mycobacterium tuberculosis. The majority of cases are secondary to extraintestinal tuberculosis, especially open pulmonary tuberculosis. The age of onset is mostly in young adults, with slightly more women than men. Zeng Yi, Department of Respiratory Medicine, Nanjing Chest Hospital Etiology Intestinal tuberculosis is generally caused by human tuberculosis bacilli, and occasionally bovine tuberculosis may develop from drinking bacteriophage milk or dairy products. Hematogenous dissemination is also one of the routes of infection of intestinal tuberculosis. It can be seen in the hematogenous spread of the tuberculosis pathway and invade the intestine. 3. Spread from adjacent TB foci Intestinal TB can also be caused by direct spread of TB foci in the abdominal cavity, such as tuberculosis of fallopian tubes, tuberculous peritonitis and mesenteric lymphatic TB. This infection is spread through the lymphatic vessels. Most of the symptoms are slow in onset and long in duration, and the typical clinical manifestations are summarized as follows: I. Abdominal pain Because the lesion often involves the ileocecal region, 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 and 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. Diarrhea and constipation Diarrhea is one of the main symptoms of ulcerative intestinal tuberculosis, which is caused by the stimulation of inflammation and ulcers in the intestinal flexure, resulting in accelerated intestinal peristalsis, rapid emptying 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 rare. In addition, there can also be constipation, stools in the shape of sheep feces, or diarrhea a constipation alternately. 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 also present, a mass can be formed and can be felt. The lump is usually located in the right lower abdomen, with medium firmness, and may have light pressure pain. Systemic symptoms Ulcerative intestinal tuberculosis often has tuberculosis toxemia, such as afternoon hypothermia, irregular fever, flaccid fever or retention fever, accompanied by night sweats, and may have signs and symptoms such as weakness, emaciation, anemic dystrophic edema, and may have extra-intestinal tuberculosis, especially tuberculous peritonitis, pulmonary tuberculosis and other related manifestations, proliferative intestinal tuberculosis mostly without symptoms of tuberculosis toxicity, longer duration of disease, better general condition. Blood picture and sedimentation The total white blood cell count is generally normal, while the red blood cell and hemoglobin are often low and mildly or moderately anemic, mostly in ulcerated patients. In patients with active lesions, blood sedimentation is often increased. Stool examination Stool concentration to find TB bacilli is only meaningful when sputum is negative. X-ray X-ray barium meal angiography or barium enema is important for the diagnosis of intestinal tuberculosis. Fiber colonoscopy can directly observe the lesions in the whole colon, cecum and ileocecal region, and biopsy or sampling for bacterial culture is possible. Treatment The treatment of intestinal tuberculosis, like pulmonary tuberculosis, should emphasize early, combined, appropriate dosage and full course of medication. Rest and nutrition Reasonable rest and nutrition should be the basis of the treatment of tuberculosis. Active intestinal tuberculosis should emphasize bed rest, reduce caloric consumption, improve nutrition and increase the body’s ability to resist disease. Second, anti-tuberculosis drug therapy Anti-tuberculosis drug selection and usage are detailed in pulmonary tuberculosis. This is the standard therapy, 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 rifampin is used, and for severe intestinal TB or those with severe extra-intestinal TB, the combination of streptomycin or pyrazinamide or ethambutol is appropriate. This short course method needs to pay attention to the damage of the drug to the liver. Rifampicin can be used instead of rifampicin, 150 mg daily, which seems to be less toxic than rifampicin. Symptomatic management and surgical treatment Abdominal pain can be treated with 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 complete intestinal obstruction, or partial intestinal obstruction that does not improve with medical treatment, acute intestinal perforation causing fecal fistula that does not improve with conservative treatment, and massive intestinal bleeding that fails to stop bleeding with 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.