Ileocecal tuberculosis

Ileocecal tuberculosis is the most common site of gastrointestinal tuberculosis, which in turn is the third most common site of extrapulmonary tuberculosis.

Pathology

Three morphological types of ileocecal tuberculosis are known:

  • ulcerative 
  • hypertrophic
  • ulcerohypertrophic

Radiographic features

Ultrasound

Ultrasound is non-specific but may show cecal wall thickening and/or lymphadenopathy.

Fluoroscopy
Barium study
  • acute-to-subacute stage
  • chronic stage
    • ileocecal valve appears fixed, rigid and incompetent
    • cecum appears conical in shape and shrunken in size
    • pulled-up cecum (away from the right iliac fossa) due to fibrotic changes in the mesocolon
CT
  • circumferential wall thickening of terminal ileum and cecum
  • asymmetric thickening of the ileocecal valve
  • mesenteric lymphadenopathy with central low attenuation areas 
  • involvement of other organs (e.g. lung)

Differential diagnosis

General imaging differential considerations include:

  • Crohn disease
    • more terminal ileal involvement compared with tuberculosis, which has more pronounced cecal involvement
    • less/no ascites
    • vascular engorgement and fibrofatty proliferation of mesentery
  • cecal carcinoma (colorectal carcinoma)
    • eccentric cecal wall thickening
    • evidence of metastatic disease
  • small bowel lymphoma
    • very thick (>2 cm thickness) bowel wall
    • lack of stricturing
    • associated lymphadenopathy +/- hepatosplenomegaly
  • amoebic colitis