Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic abdominal pain, typically localized to the right lower quadrant, associated with unintentional weight loss, low-grade evening fevers, and night sweats. History of altered bowel habits, specifically chronic constipation or obstructive symptoms including postprandial bloating and nausea. No history of recent travel to endemic areas or known TB exposure, though risk factors are noted.
Clinical Examination Findings
Abdominal examination reveals a palpable, firm, non-tender or mildly tender mass in the right iliac fossa, consistent with hypertrophic ileocecal thickening. Bowel sounds may be hyperactive or suggest partial obstruction. Signs of malnutrition or pallor may be present. Chest auscultation is performed to rule out concomitant pulmonary involvement.
Treatment Protocol
Initiate standard anti-tubercular therapy (ATT) regimen: 2 months of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (HRZE), followed by 4 months of Isoniazid and Rifampicin (HR). Surgical intervention (e.g., right hemicolectomy or stricturoplasty) is reserved for complications such as complete bowel obstruction, perforation, or refractory strictures. Monitor liver function tests and visual acuity throughout therapy.