Korean J Gastrointest Endosc.  2008 Dec;37(6):433-437.

A Case of Duodenal Fistula Caused by Intra-abdominal Tuberculous Lymphadenopathy during Anti-tuberculous Medication

• Lee KR
• Seo KS
• Cheo JH
• Choi SC
• Kim K
• Yim YG
• Hong GY
• Park SW

Abstract

Recently, the proportion of extrapulmonary tuberculosis in patients has increased in Korea. Though intestinal tuberculosis in not infrequent, a duodenal fistula caused by tuberculosis is a rare condition. A 29-year-old man was admitted to the Department of Internal Medicine because of fever and weight loss. The patient was a doctor participating in a resident fellowship. The patient was diagnosed with intra-abdominal tuberculous lymphadenopathy and was given anti-tuberculous medication. One month after the administration of medication, the patient showed symptoms and signs of duodenal obstruction because of marked duodenal wall edema and a deep ulcer on the second portion of the duodenum. A computerized tomogram and duodenography revealed the formation of a fistula at the second portion of the duodenum and the presence of abscess-forming tuberculous lymphadenopathy. The use of continuous anti- tuberculous medication resulted in the improvement of the clinical symptoms, with complete healing of the duodenal fistula and tuberculous lymphadenitis. This case suggests that transient clinical worsening in intra-abdominal tuberculous lymphadenitis may occur during an early period of anti- tuberculous medication.

Keyword

Duodenum; Fistula; Tuberculous lymphadenitis

MeSH Terms

Adult
Duodenal Obstruction
Duodenum
Edema
Fellowships and Scholarships
Fever
Fistula
Humans
Internal Medicine
Korea
Lymphatic Diseases
Tuberculosis
Tuberculosis, Lymph Node
Ulcer
Weight Loss