title: Non-healing gastro-duodenal ulcer: A rare presentation of primary abdominal tuberculosis.
abstract: BACKGROUND
  We present a case of primary gastrointestinal tuberculosis that has culminated in ulcer formation, in the absence of pulmonary involvement in an immunocompetent patient.
  
  
  METHODS
  A 28-year-old Asian male presented to casualty with a 1-week history of epigastric cramping abdominal pain and several episodes of non-bilious vomiting. The patient deteriorated clinically, becoming more cachectic and given his unexplained weight loss, an oesophageal-gastro-duodenal endoscopic imaging confirmed a duodenal ulcer. The biopsy of the non-healing ulcer was the hallmark of the disease, revealing evidence of granulomatous inflammation consistent with tuberculosis bacilli.
  
  
  CONCLUSIONS
  Gastrointestinal tuberculosis with ulceration is rare with respect to the oesophagus, stomach and duodenum. This case proves to be unique, as our patient had experienced primary isolated gastric tuberculosis in the absence of pulmonary tuberculosis in a healthy individual. Immunohistochemical staining, histopathology and radiological investigations have demonstrated their importance in confirming abdominal tuberculosis and the extent of bowel involvement.
  
  
  CONCLUSIONS
  This case has illustrated the difficulties associated with a prompt diagnosis of an unusual case of primary duodenal tuberculosis from chronic peptic ulcer disease in an immunocompetent patient.
authors.affiliation: Department of General Surgery, Princess Royal University Hospital, Farnborough, Common, Orpington, London, United Kingdom. Electronic address: nabeel.merali@gmail.com.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Merali
authors.affiliation: Department of General Surgery, Princess Royal University Hospital, Farnborough, Common, Orpington, London, United Kingdom.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chandak
authors.affiliation: Department of General Surgery, Princess Royal University Hospital, Farnborough, Common, Orpington, London, United Kingdom.
authors.forename: Sudeendra
authors.initials: S
authors.lastname: Doddi
authors.affiliation: Department of General Surgery, Princess Royal University Hospital, Farnborough, Common, Orpington, London, United Kingdom.
authors.forename: Prakash
authors.initials: P
authors.lastname: Sinha
keywords: Abdominal; Duodenum; Investigation; Pathogenesis; Tuberculosis; Ulcer