OBJECTIVE: Esophageal tuberculosis (ET) is a rare disorder often easily misdiagnosed. The aim of this study is to evaluate the clinical features and to highlight the surgical role in treatment and complication management for undiagnosed ET. METHODS: Between June 2006 and June 2011, six esophageal tuberculosis cases were retrospectively reviewed for their clinical presentations, radiological findings, endoscopic views, surgical treatment and outcome. RESULTS: The prevalent rate of ET was 0.30%. All patients, aged from 28 to 71 years, presented with dysphagia in six, weight loss in four, and each of retrosternal pain, epigastric pain, fever with cough in one. The duration ranged from two weeks to two months. Involvement of esophagus observed at middle segment in five patients, and at lower segment in one. Endoscopy demonstrated diverticulum with polyps in one patient, ulcer formation in one, and extraneous compression with intact mucosa in four. Five patients underwent video-assisted thoracoscopic surgery (VATS) and one was performed thoracotomy perforation repair for esophagopleural fistula. Diagnoses of all cases were confirmed by histopathological examination and acid-fast bacilli culture. Drug sensitivity test revealed multidrugs resistant mycobacterium tuberculous in one case. All patients discharged and recovered by antituberculous treatment with follow-up time ranged from 12 to 45 months. CONCLUSIONS: ET should be considered as a causative factor for dysphagia. Surgery should be applied in undiagnosed ET. VATS is useful in improving rate of confirmative diagnosis, and relieving symptom of dysphagia. Thoracotomy repair is reserved for complications of ET.
OBJECTIVE:Esophageal tuberculosis (ET) is a rare disorder often easily misdiagnosed. The aim of this study is to evaluate the clinical features and to highlight the surgical role in treatment and complication management for undiagnosed ET. METHODS: Between June 2006 and June 2011, six esophageal tuberculosis cases were retrospectively reviewed for their clinical presentations, radiological findings, endoscopic views, surgical treatment and outcome. RESULTS: The prevalent rate of ET was 0.30%. All patients, aged from 28 to 71 years, presented with dysphagia in six, weight loss in four, and each of retrosternal pain, epigastric pain, fever with cough in one. The duration ranged from two weeks to two months. Involvement of esophagus observed at middle segment in five patients, and at lower segment in one. Endoscopy demonstrated diverticulum with polyps in one patient, ulcer formation in one, and extraneous compression with intact mucosa in four. Five patients underwent video-assisted thoracoscopic surgery (VATS) and one was performed thoracotomy perforation repair for esophagopleural fistula. Diagnoses of all cases were confirmed by histopathological examination and acid-fast bacilli culture. Drug sensitivity test revealed multidrugs resistant mycobacterium tuberculous in one case. All patients discharged and recovered by antituberculous treatment with follow-up time ranged from 12 to 45 months. CONCLUSIONS:ET should be considered as a causative factor for dysphagia. Surgery should be applied in undiagnosed ET. VATS is useful in improving rate of confirmative diagnosis, and relieving symptom of dysphagia. Thoracotomy repair is reserved for complications of ET.
Authors: Kelly E Dooley; Ekwaro A Obuku; Nadza Durakovic; Vera Belitsky; Carole Mitnick; Eric L Nuermberger Journal: J Infect Dis Date: 2012-07-17 Impact factor: 5.226