Korean J Nephrol.  2001 Nov;20(6):1049-1052.

Bleeding from a Tuberculous Gastric Ulcer in a Hemodialysis Patient

• Lee YH
• Kim YB
• Jung DY
• Lee YK
• Kim KY
• Lee JS
• Lee JG
• Choi DL
• Park MJ
• Lee YK

Abstract

The incidence of Tuberculosis among the patients with end-stage renal disease(ESRD) has increased up to 16 times of that in the general population. The impairment of the cellular immunity in the ESRD patients may have a role in the pathogenesis. Extrapulmonary tuberculous manifestations such as lymph node, peritoneum, and pleura involvement are more frequent in the ESRD patients than in the general population. However, there has been no case of upper gastrointestinal(UGI) bleeding as a result of a gastric tuberculosis in the ESRD patient on hemodialysis. Here we report an unusual case of a hemodialysis patient with UGI bleeding secondary to a tuberculous gastric ulcer. A 31-year-old female on hemodialysis was admitted with melena. Endoscopy revealed a benign gastric ulcer with a visible bleeding vessel at the base, located in the anterior wall of the antrum. An exploratory laparotomy showed multiple, round, small and yellow nodules on the visceral peritoneum as well as a 1-cm sized gastric ulcer. After gastric resection, a histological examination including peritoneal nodules demonstrated chronic granulomatous inflamation with caseous necrosis and giant cells. The patient has been on antituberculosis medication and followed up in the outpatient department without any event for 8 months.

Keyword

Gastric tuberculosis; Upper gastriointestinal bleeding; Hemodialysis patient

MeSH Terms

Adult
Endoscopy
Female
Giant Cells
Hemorrhage*
Humans
Immunity, Cellular
Incidence
Kidney Failure, Chronic
Laparotomy
Lymph Nodes
Melena
Necrosis
Outpatients
Peritoneum
Pleura
Renal Dialysis*
Stomach Ulcer*
Tuberculosis