El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 

A 26 year-old female, two years previously underwent hysterectomy with bilateral- salpingo-ooforectomy due to a cervical carcinoma. Patient presented with severe abdominal pain with right predominance since 10 months previously. In addition the patient has been with several episodes of fever with anorexia.

Video Endoscopic Sequence 1 of 12.

 A Case of Colonic Tuberculosis Mimicking Crohn's Disease.

Intestinal Tuberculosis in AIDS

 This 26 year-old female, who underwent hysterectomy two
 years ago, with bilateral-salpingo
-ooforectomy due to
 a cervical carcinoma. The patient presented with severe
 abdominal pain with right predominance since 10 months
 previously, and weight loss her blood test for Aids, was
 positive.

 In addition the patient has been with several episodes of
 fever with anorexia.
 Aditional clinic finding of this patient, presented with
 
Oropharynge-Esophagic Candidiasis.

 Here, we report a case of isolated colonic tuberculosis
 where the initial diagnostic workup was suggestive of
 Crohn's disease. Computed tomography findings however,
 raised the possibility of colonic tuberculosis and the
 detection of acid-fast bacilli in biopsy specimens confirmed
 the diagnosis.
this case highlights the need for awareness
 of intestinal tuberculosis in the differential diagnosis of
 chronic intestinal disease.

 Download the video clips by clicking on the endoscopic
 images, if you wish to observe in full screen, wait to be
 downloaded complete then press Alt and Enter for
 Windows
media, Real Player Ctrl and 3. 
 Configure the windows media in repeat is optimal.
 All endoscopic images shown in this Atlas contain
 video clips.
We recommend seeing the video clips in full
 screen mode.
 
     

  

Nodular ulcers with thickened mucosa covered with fibrin. We could not get to the cecum, due to a lesion with severe narrowness in the ascending colon. Clinical features of intestinal TB include abdominal pain, weight loss, anemia, and fever with night sweats. Patients may present with symptoms of obstruction, right iliac fossa pain, or a palpable mass in the right iliac fossa. Hemorrhage and perforation are recognized complications of intestinal TB, although free perforation is less frequent than in Crohn disease.

Video Endoscopic Sequence 2 of 12.

 The diagnosis of colonic tuberculosis requires a high index
 of suspicion.

 Nodular ulcers with thickened mucosa covered with
 fibrin.

 We could not get to the cecum, due to a lesion with
 severe narrowness in the ascending colon.

 Clinical features of intestinal TB include abdominal pain,
 weight loss, anemia, and fever with night sweats. Patients
 may present with symptoms of obstruction, right iliac fossa
 pain, or a palpable mass in the right iliac fossa.
 Hemorrhage and perforation are recognized complications
 of intestinal TB, although free perforation is less frequent
 than in Crohn disease.

Ascendin Colon. The diagnosis of colonic tuberculosis requires a high index of suspicion. In cases where the information available does not reveal a definite differentiation between colonic tuberculosis and Crohn's disease.

Video Endoscopic Sequence 3 of 12.

 Ascendin Colon.

 The diagnosis of colonic tuberculosis requires a high index
 of suspicion. In cases where the information available does
 not reveal a definite differentiation between colonic
 tuberculosis and Crohn's disease.

 Intestinal tuberculosis is a rare disease in western
 countries, affecting mainly immigrants and
 immunocompromised patients. Intestinal tuberculosis is a
 diagnostic challenge, especially when active pulmonary
 infection is absent. It may mimic many other abdominal
 diseases.

Deep ulcerations exposing the deeper layers of the colonic wall and leaving islands of normal mucosa, with deformity of the lumen. In this case of tuberculosis of the colon resemble a  Crohn's disease, lesions are typically discontinuous. They can be adjacent to normal tissue, resulting in "skip areas" as in Crohn's disease .

Video Endoscopic Sequence 4 of 12.

 Colonic tuberculosis as a diagnostic challenge

 Deep ulcerations exposing the deeper layers of the colonic
 wall and leaving islands of normal mucosa, with deformity
 of the lumen.

 In this case of tuberculosis of the colon resemble a
 Crohn's disease, lesions are typically discontinuous.
 They can be adjacent to normal tissue, resulting in "skip
 areas" as in Crohn's disease.

 In cases where the information available does not reveal a
 definite differentiation between colonic tuberculosis and
 Crohn’s disease, corticosteroids should be withheld. The
 administration of corticosteroids to a patient with colonic
 tuberculosis may have disastrous results, and a therapeutic
 trial of antituberculous drugs should be considered instead.

IImage and video clip, after dye spraying with methylene blue the washing catheter for chromoendoscopy is appreciated. In this clinical case, the inflammatory activity of the colon was only limited to the ascending colon. We did not find any injury, neither in the rectum and descendent colon nor in the transverse.

Video Endoscopic Sequence 5 of 12.

 Image and video clip, after dye spraying with methylene
 blue the washing catheter for chromoendoscopy is
 appreciated.

 In this clinical case, the inflammatory activity of the colon
 was only limited to the ascending colon. We did not find any
 injury, neither in the rectum and descendent colon nor in
 the transverse.

Seen after staining with methylene blue. The ileocecal region is the most common site of tuberculosis in the gastrointestinal tract. The common imaging findings include thickening of the ileocecal valve and adjacent ileum and colon. At CT, mesenteric lymphadenopathy with low attenuation suggestive of necrosis is typically found, although soft-tissue attenuation nodes occasionally occur, colonic tuberculosis can take several forms, including segmental ulceration, inflammatory strictures, and hypertrophic lesions that resemble polyps and masses.

Video Endoscopic Sequence 6 of 12.

Seen after staining with methylene blue.

 The ileocecal region is the most common site of
 tuberculosis in the gastrointestinal tract. The common
 imaging findings include thickening of the ileocecal valve
 and adjacent ileum and colon.
 At CT, mesenteric lymphadenopathy with low attenuation
 suggestive of necrosis is typically found, although
 soft -tissue attenuation nodes occasionally occur, colonic
 tuberculosis can take several forms, including segmental
 ulceration, inflammatory strictures, and hypertrophic
 lesions that resemble polyps and masses.

Chromoendoscopy has been applied in a variety of clinical settings and throughout all gastrointestinal tract segments that are accessible to the endoscope.

Video Endoscopic Sequence 7 of 12.

 Chromoendoscopy has been applied in a variety of clinical
 settings and throughout all gastrointestinal tract segments
 that are accessible to the endoscope.

 The ileo-caecal area is reported to be the area most
 commonly involved in colonic tuberculosis.

A close up magnification of the lesion is observed.

Video Endoscopic Sequence 8 of 12.

 A close up magnification of the lesion is observed, using a
 magnifying video endoscope after dye spraying.
 See video clip.

 Intestinal tuberculosis is much more difficult to diagnose
 than pulmonary tuberculosis. One of the reasons is the
 very low diagnostic yield of endoscopic biopsy specimens.

 The differentiation between intestinal tuberculosis and
 Crohn’s disease based on clinical features, radiology,
 endoscopy, and histology is often difficult.

 

 A tumorlike appearance. Colonoscopic image shows that colonoscope was unable to pass stenotic segment. Severe narrowness in the ascending colon. Crohn's involving the distal colon, with severe inflammation, edema, ulcers and stenosis.

Video Endoscopic Sequence 9 of 12.

 A Tumorlike Appearance.

 Colonoscopic image shows that colonoscope was unable to
 pass stenotic segment.
 Severe narrowness in the ascending colon. Involving the
 distal colon, with severe inflammation, edema, ulcers and
 stenosis.
Because we could not pass the colonoscope
 behind the stricture, we could not examine
the ileocecal
 region.

 

The lymph nodes, peritoneum, and gastrointestinal tract are the most common sites of such involvement . In the gastrointestinal tract, common locations include the ileum, colon, and ileocecal valve, although any part of the gut may be involved.

Video Endoscopic Sequence 10 of 12.

 The colonoscope could not be introduced beyond the lesion.

 Colonoscopy revealed a tumorous lesion in the ascending
 colon near the caecum

 The lymph nodes, peritoneum, and gastrointestinal tract
 are the most common sites of such involvement . In the
 gastrointestinal tract, common locations include the ileum,
 colon, and ileocecal valve, although any part of the gut
 may be involved
.

Seen after staining with methylene blue. Tuberculosis.--M tuberculosis is the most common cause of serious HIV-related infection worldwide, although it is less common in the United States than in other countries. About 43% of HIV-infected persons develop tuberculosis in developing countries , whereas only 4% develop tuberculosis in the United States. Tuberculosis in HIV-infected patients tends to occur earlier than other AIDS-defining opportunistic infections, usually when the patient's CD4 cell count is in the range of 150 350 cells per microliter.

Video Endoscopic Sequence 11 of 12.

Seen after staining with methylene blue.

 Tuberculosis.--M tuberculosis is the most common cause of
 serious HIV-related infection worldwide, although it is less
 common in the United States than in other countries. About 43%
 of HIV-infected persons develop tuberculosis in developing
 countries , whereas only 4% develop tuberculosis in the United
 States. Tuberculosis in HIV-infected patients tends to occur
 earlier than other AIDS-defining opportunistic infections, usually
 when the patient's CD4 cell count is in the range of 150 350 cells
 per microliter.

A close-up image. For more endoscopic details download the video clips by clicking on the images. The importance of considering tuberculosis in patients presenting with Crohn's disease. In this regard colonoscopy with tissue culture of targeted biopsy may be a valuable aid in establishing the diagnosis of tuberculous colitis.

Video Endoscopic Sequence 12 of 12.

 A close-up image.

 For more endoscopic details download the video clips
 by clicking on the images.

 The importance of considering tuberculosis in patients
 presenting with Crohn's disease. In this regard colonoscopy
 with tissue culture of targeted biopsy may be a valuable
 aid in establishing the diagnosis of tuberculous colitis.

This 54-year-old male fisherman, was seen as an emergency because of massive rectal bleeding, his hemoglobin was 6.3 GR./dl, serology for HIV was negative, Rectal examination revealed dark, red blood on the examining finger, two moths previously undergone a cerebral surgery due to an astrocitoma.

Video Endoscopic Sequence 1 of 11.

 This 54-year-old male fisherman, was seen as an
 emergency because of massive rectal bleeding, his
 hemoglobin was 6.3 GR./dl, serology for HIV was negative,
 Rectal examination revealed dark, red blood on the
 examining finger, two moths previously undergone a
 cerebral surgery due to an astrocitoma.

 A full colonoscopy was carried out in order to determinate
 the exact etiology of this hemorrhage of the patient, in this
 image and the video clip shows some diverticulae and dark
 blood.

The main symptom of lower GI bleeding is blood exiting the anus, either alone (bright red blood per rectum) or as red-stained stool (hematochezia). Stool that is tarry and dark (melena) typically points to upper GI bleeding. Otherwise, bleeding over time results in anemia, characterized by lower than normal blood hemoglobin and hematocrit with symptoms like weakness, fatigue, and fainting.

Video Endoscopic Sequence 2 of 11.

The colon was seen to be filled with dark blood.

 The main symptom of lower GI bleeding is blood exiting the
 anus, either alone (bright red blood per rectum) or as
 red-stained stool (hematochezia). Stool that is tarry and
 dark (melena) typically points to upper GI bleeding.
 Otherwise, bleeding over time results in anemia,
 characterized by lower than normal blood hemoglobin and
 hematocrit with symptoms like weakness, fatigue, and
 fainting.

Intestinal tuberculosis (TB) is rarely seen in western countries, affecting mainly immigrants and immunocompromised patients. However, the incidence of abdominal TB has been steadily increasing for the past 20 years and a reported 2-3% of patients with abdominal TB have isolated colonic involvement. Intestinal TB is usually a diagnostic challenge, particularly in the absence of active pulmonary infection. It may mimic many other abdominal diseases, such as other infectious processes, tumors, periappendiceal abscess, and Crohn's disease (CD). Several cases of intestinal TB have so far been described including a few reports of intestinal TB mimicking CD. The differential diagnosis between TB and CD is important because if TB is suspected, empiric treatment with antituberculous drugs should be considered, especially if an immunosuppresive treatment for CD is to be initiated.

Video Endoscopic Sequence 3 of 11.

 Large ulcer with an elevated margin

 Intestinal tuberculosis (TB) is rarely seen in western
 countries, affecting mainly immigrants and
 immunocompromised patients. However, the incidence of
 abdominal TB has been steadily increasing for the past 20
 years and a reported 2–3% of patients with abdominal TB
 have isolated colonic involvement. Intestinal TB is usually
 a diagnostic challenge, particularly in the absence of active
 pulmonary infection. It may mimic many other abdominal
 diseases, such as other infectious processes, tumors,
 periappendiceal abscess, and Crohn's disease (CD).
 Several cases of intestinal TB have so far been described
 including a few reports of intestinal TB mimicking CD. The
 differential diagnosis between TB and CD is important
 because if TB is suspected, empiric treatment with
 antituberculous drugs should be considered, especially if
 an immunosuppresive treatment for CD is to be initiated.

 

The apparent affinity of the tubercle bacillus for lymphoid tissue and areas of physiologic stasis facilitating prolonged contact between the bacilli and the mucosa may be the reasons for the ileum and cecum being the most common sites of disease. Other areas of the colon besides the ileocaecal area represent the next more common site of tuberculous involvement of the GI tract, usually manifested as segmental colitis involving the ascending and transverse colon.

Video Endoscopic Sequence 4 of 11.

 The apparent affinity of the tubercle bacillus for lymphoid
 tissue and areas of physiologic stasis facilitating prolonged
 contact between the bacilli and the mucosa may be the
 reasons for the ileum and cecum being the most common
 sites of disease. Other areas of the colon besides the
 ileocaecal area represent the next more common site of
 tuberculous involvement of the GI tract, usually manifested
 as segmental colitis involving the ascending and transverse
 colon.

Colonic TB may present as an inflammatory stricture, hypertrophic lesions resembling polyps or tumors, segmental ulcers and colitis or rarely, diffuse tuberculous colitis. The diagnosis can be quite difficult since there are no specific clinical symptoms of large bowel TB and only a quarter of patients have chest radiographs showing evidence of active or healed pulmonary infection. The clinical, radiological and endoscopic picture is most likely to be confused with neoplasms or Crohn's disease, and infrequently with other considerations including amoeboma, Yersinia infection, GI histoplasmosis, and periappendiceal abscess.

Video Endoscopic Sequence 5 of 11.

 The cecum area showing ulceration of the ileocecal valve

 Colonic TB may present as an inflammatory stricture,
 hypertrophic lesions resembling polyps or tumors,
 segmental ulcers and colitis or rarely, diffuse tuberculous
 colitis. The diagnosis can be quite difficult since there are
 no specific clinical symptoms of large bowel TB and only a
 quarter of patients have chest radiographs showing
 evidence of active or healed pulmonary infection. The
 clinical, radiological and endoscopic picture is most likely
 to be confused with neoplasms or Crohn's disease, and
 infrequently with other considerations including amoeboma,
 Yersinia infection, GI histoplasmosis, and periappendiceal
 abscess.

 

The median duration of symptoms is usually less than one year. Pain predominantly in the lower abdomen is the commonest symptom of presentation. In one-third of patients lower gastrointestinal bleeding is present. Fever, anorexia, weight loss and altered bowel habit are the other manifestations. Obstruction, massive bleeding and rarely perforation are the complications reported.

Video Endoscopic Sequence 6 of 11.

 The median duration of symptoms is usually less than one
 year. Pain predominantly in the lower abdomen is the
 commonest symptom of presentation. In one-third of
 patients lower gastrointestinal bleeding is present. Fever,
 anorexia, weight loss and altered bowel habit are the other
 manifestations. Obstruction, massive bleeding and rarely
 perforation are the complications reported

 

Tuberculosis may affect any part of the gastrointestinal tract, but it most commonly involves the terminal ileum and ileocaecal region, as does Crohn's disease.

Video Endoscopic Sequence 7 of 11.

 Tuberculosis may affect any part of the gastrointestinal
 tract, but it most commonly involves the terminal ileum and
 ileocaecal region, as does Crohn’s disease.

 

Colonoscopy is a non-invasive procedure that provides much information about the mas and nature of involvement and facilitates biopsy collection. Colonoscopic findings of nodular, noduloulcerative or ulcerative lesions with erythematous surrounding mucosa and thickened edematous ileocecal valve are suggestive of Tuberculosis.

Video Endoscopic Sequence 8 of 11.

 Colonoscopy is a non-invasive procedure that provides
 much information about the mas and nature of involvement
 and facilitates biopsy collection. Colonoscopic findings of
 nodular, noduloulcerative or ulcerative lesions with
 erythematous surrounding mucosa and thickened
 edematous ileocecal valve are suggestive of Tuberculosis.

Video Endoscopic Sequence 9 of 11.

 In this video multiple ulcers of the ascending colon and
 cecum are observed with the retroflexed maneuver that
 was performed from the cecum all the way to the rectum
 using a adult colonoscope.

 This video is of great size is recommended to download
 with a fast connection of internet.

Inflammatory stricture, hypertrophic lesions resembling polyp or tumor, segmental transverse ulcers and segmental or diffuse colitis are the pathological presentations of colonic tuberculosis.

Video Endoscopic Sequence 10 of 11.

 Inflammatory stricture, hypertrophic lesions resembling
 polyp or tumor, segmental transverse ulcers and
 segmental or diffuse colitis are the pathological
 presentations of colonic tuberculosis.

 With the resurgence of tuberculosis as a result of HIV, it is
 important to keep this diagnosis foremost and manage it
 medically, if possible.

 

 

Colonic tuberculosis can present in several forms. The most common involvement is in the form of segmental ulcers and colitis, inflammatory strictures and hypertrophic lesions resembling polyps or masses.

Video Endoscopic Sequence 11 of 11.

 Colonic tuberculosis can present in several forms.
 The most common involvement is in the form of segmental
 ulcers and colitis, inflammatory strictures and hypertrophic
 lesions resembling polyps or masses.

 The colonoscopic features of colonic tuberculosis include
 erythema, mucosal nodules, ulcers, strictures, and a
 deformed ileocaecal valve. These features are
 non-specific, however, and can also occur in Crohn’s
 disease. In contrast, distinguishing histological features of
 granulomas in intestinal tuberculosis and Crohn’s disease
 have been described.  Caseation, if present, strongly
 suggests tuberculosis, but central acute necrosis of
 granulomas may also be seen occasionally in
Crohn’s
 disease. Further, hyalinisation of granulomas is a typical
 feature of tuberculosis but is uncommon in
 Crohn’s disease. One must bear in mind, however, that
 sampling error on biopsy may lead to the failure of
 detecting granulomas in biopsy specimens from patients
 with either condition. In addition, granulomas in colonic
 tuberculosis may not always show caseation, despite
 repeated, multiple colonoscopic biopsies.