Gastrocolic fistula in a patient with gastrointestinal tuberculosis: a case report from Nepal, a tuberculosis endemic region.

INTRODUCTION AND

IMPORTANCE

Tuberculosis (TB) is known to manifest in various forms. A gastrocolic fistula can be one such presentation of gastrointestinal TB.

CASE PRESENTATION: A 52-year-old female presented with recurrent episodes of postprandial pain, vomiting, fever with evening rise, and significant loss of weight. Esophagogastroduodenoscopy revealed proliferative growth with an opening involving the antrum of the stomach. Multiple biopsies were obtained, which revealed mycobacterium tuberculosis (MTB) on histopathology and polymerase chain reaction. A computed tomography of the abdomen confirmed a gastrocolic fistula. Distal gastrectomy with gastrojejunostomy and right hemicolectomy with ileocolonic anastomosis was performed in addition to the initiation of antitubercular therapy (ATT). She improved with this approach and is on regular follow-up.

CLINICAL DISCUSSION: Gastrointestinal TB is a rare form of TB. In rare instances, it can manifest as a gastrocolic fistula. TB is a curable disease, and with timely treatment, significant comorbidity can be prevented. All possible efforts should be made to diagnose this entity. The cornerstone of diagnosis is histological analysis of the obtained biopsy or surgical specimen. If available, an MTB polymerase chain reaction analysis can provide a rapid diagnosis. For the diagnosis of fistula, cross-sectional imaging is crucial in conjunction with endoscopic examination. Optimal management requires surgical removal and repair of the affected segment, along with ATT for 6 months. Although TB is becoming rarer than ever, it remains a common health problem in developing nations like Nepal.

CONCLUSION

In TB-endemic regions, TB should be considered and actively investigated as a possible cause of gastrocolic fistula, a curable condition.