title: An unusual case of gastric outlet obstruction caused by tuberculosis: challenges in diagnosis and treatment.
abstract: Gastroduodenal tuberculosis (GDTB) is rare in the West. Its presentation can be non-specific and often mimics other more common conditions such as peptic ulcer disease, malignancy and Crohn's disease. Our case describes a 33-year-old Indian immigrant who presented with a 3-year history of dyspepsia and underwent balloon dilation for gastric outlet obstruction (GOO). While biopsies from the duodenum revealed only non-caseating granuloma, a high index of suspicion was maintained and colonoscopy, performed despite the absence of lower gastrointestinal symptoms, revealed a single discrete nodular and ulcerated area in the proximal transverse colon; this eventually grew Mycobacterium tuberculosis. Our patient avoided undergoing major surgery and was successfully treated with balloon dilation and antitubercular medication. We highlight the importance of having a concerted, proactive approach to diagnosis. We discuss the therapeutic challenges involving this rare condition and explain the rationale for high-dose antisecretory therapy.
authors.affiliation: Department of Gastroenterology, Midstaffordshire NHS Trust, Stafford, UK. phk10@yahoo.com
authors.forename: Hari
authors.initials: H
authors.lastname: Padmanabhan
authors.forename: Alexander
authors.initials: A
authors.lastname: Rothnie
authors.forename: Pradip
authors.initials: P
authors.lastname: Singh
mesh_terms: D000328:Adult; D003106:Colon / Q000382:microbiology*; D004378:Duodenal Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D004386:Duodenum / Q000473:pathology*; D017219:Gastric Outlet Obstruction / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis; D013270:Stomach / Q000473:pathology*; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy