Age/sex: 2-year-old male
Size: 18.0 x 18.0 x 7.0 cm
The specimen consists of the terminal ileum that has been "folded" for display (I) and the cecum (C). Several foci of ulceration can be seen in the ileum (arrows). The patient also had tuberculosis of the lungs, brain, and kidneys.
Intestinal tuberculosis
The distal ileum and cecum are the commonest sites of intestinal tuberculosis. The infection can develop in several ways, including:
- ingestion of contaminated food or milk (so called primary intestinal tuberculosis, caused by Mycobacterium bovis);
- swallowing sputum infected with Mycobacterium tuberculosis from a focus of pulmonary disease;
- spread via the blood as part of dissemination throughout the body (miliary tuberculosis, see Specimen 12).
Once the infection is established, granulomatous inflammation and necrosis follow in the same fashion as in the lungs (see Specimen 11). Ulceration of the mucosa, complicated by bleeding, may develop. If the affected individual does not die of acute disease, fibrosis can occur, sometimes leading to stricture and bowel obstruction.
Below: A CT scan showing thickening of the terminal ileum caused by tuberculosis infection (arrow). The proximal bowel loops are dilated suggesting obstruction.
Source: Shah, V. (2019). Terminal ileal tuberculosis. Radiopaedia. https:// radiopaedia.org/cases/68643
