Tuberculosis of the terminal ileum

The incidence of intestinal tuberculosis has dramatically decreased over the past 25 years, and is reflected by the scarcity of case reports in the recent literature. The annotation, therefore, of a further proven case appears to be justified and may also serve as a reminder that the condition should always be borne in mind in the differential diagnosis of ileo-caecal lesions, particularly since there has been a suggestion (Amerson and Martin, 1964) that the incidence of gastrointestinal tuberculosis is on the increase due to the development of resistant strains of the bacillus. Howell and Knapton (1964), presenting a personal series of cases over the 12-year period 1951-62, found seven proven cases of ileo-caecal tuberculosis and six presumed cases. All authors agree that the condition is rare now in the western hemisphere. Ukil (1942) records 1,000 cases in India. The condition is usually secondary to pulmonary tuberculosis. In the series of Howell and Knapton, seven patients had evidence of pulmonary disease, although in only two were bacilli recovered; in six patients the lung fields were normal radiologically and there was no evidence of tuberculosis elsewhere. Ukil found that 95% of his cases were secondary to pulmonary tuberculosis. A pre-operative diagnosis is unlikely: usually a regional ileitis is suggested. Even at operation the diagnosis may be difficult.