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Dilemma in the Management of Concurrent Colonic Adenocarcinoma, Pulmonary Tuberculosis and Intestinal Tuberculosis: A Case Report

Received: 21 March 2023    Accepted: 27 April 2023    Published: 5 August 2023
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Abstract

Tuberculosis usually affect respiratory system. However, up to 5% can present with abdominal manifestation and one of the common locations is in the ileocecal region. Ileocaecal tuberculosis and caecal tumour can be masquerading each other in term of their clinical presentations, endoscopic features and the appearances in CT scan. There are many reported cases where intestinal tuberculosis was misdiagnosed for a colon carcinoma and vice versa. The final diagnosis is usually either one of these and in almost all the cases, the diagnosis was confirmed post operatively based of histopathology report of the surgical specimen. With a single diagnosis, the management will be more straightforward. Management dilemma will arise when multiple pathology ie; caecal tumour, pulmonary tuberculosis and ileocaecal tuberculosis, diagnosed simultaneously in a patient with colonic symptoms that need early treatment. A structured management plan will be needed to treat all these conditions affectively and safely. We are presenting a challenging case of a concurrent colon carcinoma, pulmonary tuberculosis and intestinal tuberculosis which were diagnose in a single setting. With the involvement of multidisciplinary team, an ideal treatment strategy was structured and patient was managed successfully with a combination of surgical and medical treatment.

Published in Advances in Surgical Sciences (Volume 11, Issue 2)
DOI 10.11648/j.ass.20231102.12
Page(s) 29-31
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Colon Cancer, Tuberculosis (TB), Anti-TB

References
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[2] Maulahela, H., Simadibrata, M., Nelwan, E. J., Rahadiani, N., Renesteen, E., Suwarti, S. W. T., & Anggraini, Y. W. (2022). Recent advances in the diagnosis of intestinal tuberculosis. BMC gastroenterology, 22 (1), 1-10.
[3] Prabhakar, N., & Kalra, N. (2022). Imaging of Intestinal Tuberculosis. In Tuberculosis of the Gastrointestinal system (pp. 123-138). Singapore: Springer Nature Singapore.
[4] Zeng, J., Zhou, G., & Pan, F. (2023). Clinical Analysis of Intestinal Tuberculosis: A Retrospective Study. Journal of Clinical Medicine, 12 (2), 445.
[5] Yu, S. M., Park, J. H., Kim, M. D., Lee, H. R., Jung, P., Ryu, T. H.,... & Lee, I. S. (2012). A case of sigmoid colon tuberculosis mimicking colon cancer. Journal of the Korean Society of Coloproctology, 28 (5), 275.
[6] Panthi, S., Khatiwada, P., Adhikari, S., Acharya, R., Neupane, D., Sharma, A.,... & Khanal, B. (2022). Intestinal tuberculosis masquerading as carcinoma colon: a case report of diagnostic quandary in low-resource setting. Journal of Surgical Case Reports, 2022 (5), rjac210.
[7] Lakhe, P., Khalife, A., & Pandya, J. (2017). Ileocaecal and transverse colonic tuberculosis mimicking colonic malignancy–A case report. International journal of surgery case reports, 36, 4-7.
[8] Aporowicz, M., Zrąbkowski, M., Iwaneczko, E., & Czopnik, P. (2023). Suspicion of synchronous colon carcinoma that turned out to be abdominal tuberculosis. Polish Archives of Internal Medicine, 16457-16457.
[9] Veettil, S. K., Lim, K. G., Chaiyakunapruk, N., Ching, S. M., & Hassan, M. R. A. (2017). Colorectal cancer in Malaysia: Its burden and implications for a multiethnic country. Asian journal of surgery, 40 (6), 481-489.
[10] Zamri, H. F., Ruzan, I. N., Ramli, S. R., & Ahmad, N. (2022). Predominance of the East-Asian Beijing genotype in a Mycobacterium tuberculosis drug-resistant population in Central Malaysia. Journal of Global Antimicrobial Resistance, 30, 302-307.
[11] Debi, U., Ravisankar, V., Prasad, K. K., Sinha, S. K., & Sharma, A. K. (2014). Abdominal tuberculosis of the gastrointestinal tract: revisited. World Journal of Gastroenterology: WJG, 20 (40), 14831.
[12] Jha, D. K., Pathiyil, M. M., & Sharma, V. (2023). Evidence-based approach to diagnosis and management of abdominal tuberculosis. Indian Journal of Gastroenterology, 1-15.
[13] Kedia, S., & Ahuja, V. (2022). Intestinal Tuberculosis: An Overview. Tuberculosis of the Gastrointestinal system, 73-103.
[14] Joint Tuberculosis Committee of the British Thoracic Society. (2000). Control and prevention of tuberculosis in the United Kingdom: code of practice 2000. Thorax, 55 (11), 887-901.
[15] Hirashima, T., Tamura, Y., Han, Y., Hashimoto, S., Tanaka, A., Shiroyama, T.,... & Nagai, T. (2018). Efficacy and safety of concurrent anti-Cancer and anti-tuberculosis chemotherapy in Cancer patients with active Mycobacterium tuberculosis: a retrospective study. BMC cancer, 18 (1), 1-10.
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  • APA Style

    Subhathira Manohkaran. (2023). Dilemma in the Management of Concurrent Colonic Adenocarcinoma, Pulmonary Tuberculosis and Intestinal Tuberculosis: A Case Report. Advances in Surgical Sciences, 11(2), 29-31. https://doi.org/10.11648/j.ass.20231102.12

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    ACS Style

    Subhathira Manohkaran. Dilemma in the Management of Concurrent Colonic Adenocarcinoma, Pulmonary Tuberculosis and Intestinal Tuberculosis: A Case Report. Adv. Surg. Sci. 2023, 11(2), 29-31. doi: 10.11648/j.ass.20231102.12

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    AMA Style

    Subhathira Manohkaran. Dilemma in the Management of Concurrent Colonic Adenocarcinoma, Pulmonary Tuberculosis and Intestinal Tuberculosis: A Case Report. Adv Surg Sci. 2023;11(2):29-31. doi: 10.11648/j.ass.20231102.12

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  • @article{10.11648/j.ass.20231102.12,
      author = {Subhathira Manohkaran},
      title = {Dilemma in the Management of Concurrent Colonic Adenocarcinoma, Pulmonary Tuberculosis and Intestinal Tuberculosis: A Case Report},
      journal = {Advances in Surgical Sciences},
      volume = {11},
      number = {2},
      pages = {29-31},
      doi = {10.11648/j.ass.20231102.12},
      url = {https://doi.org/10.11648/j.ass.20231102.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20231102.12},
      abstract = {Tuberculosis usually affect respiratory system. However, up to 5% can present with abdominal manifestation and one of the common locations is in the ileocecal region. Ileocaecal tuberculosis and caecal tumour can be masquerading each other in term of their clinical presentations, endoscopic features and the appearances in CT scan. There are many reported cases where intestinal tuberculosis was misdiagnosed for a colon carcinoma and vice versa. The final diagnosis is usually either one of these and in almost all the cases, the diagnosis was confirmed post operatively based of histopathology report of the surgical specimen. With a single diagnosis, the management will be more straightforward. Management dilemma will arise when multiple pathology ie; caecal tumour, pulmonary tuberculosis and ileocaecal tuberculosis, diagnosed simultaneously in a patient with colonic symptoms that need early treatment. A structured management plan will be needed to treat all these conditions affectively and safely. We are presenting a challenging case of a concurrent colon carcinoma, pulmonary tuberculosis and intestinal tuberculosis which were diagnose in a single setting. With the involvement of multidisciplinary team, an ideal treatment strategy was structured and patient was managed successfully with a combination of surgical and medical treatment.},
     year = {2023}
    }
    

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    Y1  - 2023/08/05
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    DO  - 10.11648/j.ass.20231102.12
    T2  - Advances in Surgical Sciences
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    UR  - https://doi.org/10.11648/j.ass.20231102.12
    AB  - Tuberculosis usually affect respiratory system. However, up to 5% can present with abdominal manifestation and one of the common locations is in the ileocecal region. Ileocaecal tuberculosis and caecal tumour can be masquerading each other in term of their clinical presentations, endoscopic features and the appearances in CT scan. There are many reported cases where intestinal tuberculosis was misdiagnosed for a colon carcinoma and vice versa. The final diagnosis is usually either one of these and in almost all the cases, the diagnosis was confirmed post operatively based of histopathology report of the surgical specimen. With a single diagnosis, the management will be more straightforward. Management dilemma will arise when multiple pathology ie; caecal tumour, pulmonary tuberculosis and ileocaecal tuberculosis, diagnosed simultaneously in a patient with colonic symptoms that need early treatment. A structured management plan will be needed to treat all these conditions affectively and safely. We are presenting a challenging case of a concurrent colon carcinoma, pulmonary tuberculosis and intestinal tuberculosis which were diagnose in a single setting. With the involvement of multidisciplinary team, an ideal treatment strategy was structured and patient was managed successfully with a combination of surgical and medical treatment.
    VL  - 11
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Author Information
  • General Surgery Department, Hospital Selayang, Selangor, Malaysia

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