A rare case of upper gastrointestinal hemorrhage due to tuberculous lymphadenitis fistulized in the duodenum
Dublin Core
Title
A rare case of upper gastrointestinal hemorrhage due to tuberculous lymphadenitis fistulized in the duodenum
Subject
Fistulization, Hemorrhage, Lymphadenitis, Tuberculosis
Description
Abstract
Introduction Abdominal tuberculosis is less prevalent than pulmonary tuberculosis. Tuberculous lymphadenitis
accounts for fewer than 5% of abdominal cases. An unusual complication is the fistulization of a tuberculous lymph
node into the digestive tract, with an even rarer association with upper gastrointestinal bleeding.
Case Report A 63-year-old male with a history of rectal adenocarcinoma surgery presented with severe
gastrointestinal bleeding that required multiple transfusions. Endoscopic attempts failed to locate the bleeding
source, but CT angiogram revealed a hemorrhagic necrotic mesenteric lymph node with a fistula to the second part
of the duodenum. The patient underwent surgery, which involved resecting the lymph nodes and disconnecting
the fistula. Histopathological findings confirmed tuberculous mesenteric lymphadenitis, and the patient was
subsequently started on HRZE therapy. Six months postoperatively, there was no recurrence of bleeding.
Discussion Gastroduodenal tuberculosis is infrequent due to factors such as the high acidity of the gastric
environment and limited lymphoid tissue. Symptoms may mimic other abdominal conditions, making diagnosis
challenging. Common complications include gastric outlet obstruction and perforation, while gastrointestinal
bleeding is rare. This case of hemorrhagic tuberculous lymphadenitis with fistulization highlights the need for a
high index of suspicion and the role of imaging in diagnosing uncommon bleeding sources. While anti-tuberculosis
therapy remains the primary treatment, surgery is warranted in cases involving refractory bleeding or fistulization.
Conclusion This case emphasizes the importance of a multidisciplinary approach to abdominal tuberculosis with
atypical presentations. Awareness of rare complications is essential for prompt diagnosis and management.
Keywords Fistulization, Hemorrhage, Lymphadenitis, Tuberculosis
Introduction Abdominal tuberculosis is less prevalent than pulmonary tuberculosis. Tuberculous lymphadenitis
accounts for fewer than 5% of abdominal cases. An unusual complication is the fistulization of a tuberculous lymph
node into the digestive tract, with an even rarer association with upper gastrointestinal bleeding.
Case Report A 63-year-old male with a history of rectal adenocarcinoma surgery presented with severe
gastrointestinal bleeding that required multiple transfusions. Endoscopic attempts failed to locate the bleeding
source, but CT angiogram revealed a hemorrhagic necrotic mesenteric lymph node with a fistula to the second part
of the duodenum. The patient underwent surgery, which involved resecting the lymph nodes and disconnecting
the fistula. Histopathological findings confirmed tuberculous mesenteric lymphadenitis, and the patient was
subsequently started on HRZE therapy. Six months postoperatively, there was no recurrence of bleeding.
Discussion Gastroduodenal tuberculosis is infrequent due to factors such as the high acidity of the gastric
environment and limited lymphoid tissue. Symptoms may mimic other abdominal conditions, making diagnosis
challenging. Common complications include gastric outlet obstruction and perforation, while gastrointestinal
bleeding is rare. This case of hemorrhagic tuberculous lymphadenitis with fistulization highlights the need for a
high index of suspicion and the role of imaging in diagnosing uncommon bleeding sources. While anti-tuberculosis
therapy remains the primary treatment, surgery is warranted in cases involving refractory bleeding or fistulization.
Conclusion This case emphasizes the importance of a multidisciplinary approach to abdominal tuberculosis with
atypical presentations. Awareness of rare complications is essential for prompt diagnosis and management.
Keywords Fistulization, Hemorrhage, Lymphadenitis, Tuberculosis
Creator
Souhaib Atri1
, Mahdi Hammami1*, Anis Belhadj2
, Faouzi Chebbi2
, Youssef Chaker1
and Montassar Kacem1
, Mahdi Hammami1*, Anis Belhadj2
, Faouzi Chebbi2
, Youssef Chaker1
and Montassar Kacem1
Source
https://doi.org/10.1186/s12245-025-00883-7
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Souhaib Atri1
, Mahdi Hammami1*, Anis Belhadj2
, Faouzi Chebbi2
, Youssef Chaker1
and Montassar Kacem1, “A rare case of upper gastrointestinal hemorrhage due to tuberculous lymphadenitis fistulized in the duodenum,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12769.