In recent years the incidence of intestinal TB in developed countries has increased. In the UK higher rates have been identified in non-UK born individuals. This reflects increasing levels of disease in areas from which migrants are coming to the UK and increasing numbers arriving from high incidence areas 1.
In Northern Ireland the incidence of TB is rising, with a notification rate of 4.7/100,000 in 2004 (compared with 24.6/100,000 in Poland). Furthermore, the proportion of non-UK born cases of TB in Northern Ireland rose to 37% of those reported in 20062.
Intestinal TB presents a diagnostic challenge. Patients can present with abdominal pain, diarrhoea and weight loss, mimicking IBD3. The ileo-caecal region is the most frequent site of intestinal TB (similar to classical Crohn's). Colonic mucosal ulceration is often segmental and may be indistinguishable from Crohn's disease endoscopically. Colonoscopy is valuable in aiding the histopathological diagnosis of ileo-caecal disease4. The presence of caseating granulomata differentiates intestinal TB5. Identification of acid-fast bacilli together with isolation of mycobacteria confirms the diagnosis.
Intestinal TB is primarily managed with anti-tuberculous agents. Surgical intervention is reserved for complications including perforation which is an uncommon but serious complication with high mortality rates. Perforations may be solitary or multiple and surgical resection is required.
With an increasing incidence of TB and a rising immigrant population this case demonstrates the importance of considering intestinal TB in patients, particularly non-UK born, who present with symptoms suggestive of IBD. The role of endoscopic biopsy in differentiating intestinal TB from Crohn's disease is highlighted. This case also underlines the importance of recognition of perforated intestinal TB and the role of timely surgery.