GI Radiography

Case 1 :
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A 23 year old male presented with chief complaints of epigastric pain and vomiting of stale food since 6 months. Clinical examination and routine laboratory findings were normal. Ultrasound examination was unremarkable. An upper GI series study was requested. What is your diagosis ?
Radiograph shown is a spot film of duodenal bulb and C-loop.

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Answer : Duodenal tuberculosis

Tuberculosis of the gastrointestinal tract most often affects the ileo ceccal region. Duodenal involvement is rare, and accounts for only 2.5 % of tuberculous enteritis. Duodenal tuberculosis occurs either due to intrinsic involvement by ulceration and stricture formation or due to extrinsic compression by enlarged tuberculous lymph nodes. Three types of lesions are recognized with intrinsic involvement : ulcerative, hypertrophic and ulcerohypertrophic; the third part of duodenum is the most commonly affected site. Radiological findings in duodenal TB may reveal sharp cut off at the site of obstruction suggesting extrinsic compression, widening of the duodenal loop, thickened mucosal folds, spasm or narrowing of the lumen, flattening of mucosal folds, and thumbprinting. Obstructive jaundice secondary to fibrosis in healing duodenal TB or due to compression of the common bile duct due to enlarged tuberculous lymph nodes at the porta hepatis and peri pancreatic region have been reported.

References : Gupta SK, Jain AK, Gupt JP, Agarwal AK, Berry K. Duodenal tuberculosis. Clin Radiol 1988; 39 :159-61. Tishler JMA. Duodenal tuberculosis. Radiology 1979; 30: 593-5.