IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 5, Issue 5 (Mar.- Apr. 2013), PP 34-38 www.iosrjournals.org www.iosrjournals.org 34 | Page Co existing Abdominal Tuberculosis and Mucinous Adenocarcinoma of Colon: Coincidence or Causal Nexus? 1 SM Ikhwan, 1 LS Bob, 2 AAM Zin, 1 Z Zaidi 1, Department of Surgery School of Medical Sciences Universiti Sains Malaysia Health Campus 16150 Kubang Kerian Kelantan, Malaysia 2 Department of Pathology School of Medical Sciences Universiti Sains Malaysia Health Campus 16150 Kubang Kerian Kelantan, Malaysia Abstract: Abdominal tuberculosis and colonic carcinoma at this part of the world are very common but co- existing abdominal tuberculosis and mucinous adenocarcinoma is unusual and is considered a rare entity. We had a patient who was diagnosed as splenic flexure carcinoma with lung metastasis preoperatively. Due to bleeding tumour, we proceeded with tumour debulking, gastrojejunostomy and creation of end- stoma. Histopathology showed features of both mucinous adenocarcinoma and abdominal tuberculosis. Literature was reviewed and found that very few of such cases have been reported. Most of these cases shared some common features with predominant involvement of younger age group, right sided colonic involvement and predominantly a mucinous adenocarcinoma. The cause-effect relationship between these two conditions has been discussed and debatable. We postulated that this patient most likely had colonic carcinoma initially, then subsequently infected with tuberculosis. However, there is still no definitive cause-effect relation could be ascertained and lots of study are needed to detect or explain the association between these two different pathologies. I. Introduction Abdominal tuberculosis and colonic carcinoma are very common conditions but the sites of predilection differ with tuberculosis being more common in the ileocaecal junction or terminal ileum and carcinoma in the distal large bowel or left sided colon; and both occurring at same site is a very rare entity. Although there are few cases have been reported, so far no cause-effect relation could be defined. The objective of writing this case report is to report the rare case and reviewing the literature, aiming to answer whether both the pathologies just merely co-incidence or is there any cause-effect relation between these two conditions. CASE REPORT A 47-year old gentleman was referred to us from a district hospital with 1 month history of watery diarrhea. The frequency was ~5 times daily and there was no blood or mucus in the stool. It was associated with colicky abdominal pain and tenesmus. He also had constitutional symptoms such as anorexia and significant loss of weight (20kg over the last 5 months). He was symptomatic of anemia with lethargy, palpitations and occasionally shortness of breath. In fact, he was admitted twice to the district hospital 4 months and 2 weeks ago preceding current admission for symptomatic anemia and blood transfusion was given. Hematological investigations showed microcytic hypochromic anemia. He had no chronic medical illness or any history of tuberculosis. He denied history of night sweat, chronic cough or any contact with pulmonary tuberculosis patient. Also, he had no previous history of surgery. Clinically he was a middle aged gentleman, cachexia, pale, weight 37kg, afebrile, blood pressure of 100/70mmHg and heart rate of 78/min. There was no cervical lymph node palpable. Abdomen was soft, not distended, non-tender and no mass was palpable, hernia orifices were intact and no hepato-splenomegaly; but there was presence of ascites. Digital rectal examination revealed empty rectum and no mass palpable. Other systemic examinations including cardiovascular and lungs were normal. There was minimal pedal edema bilaterally. Biochemically, his haemoglobin was 8.6g/dl, total white cells 13,000, potassium 3.0mmol/L, albumin 18g/dL. Liver enzymes were normal. Colonoscopy was performed showing tumour at 70cm from anal verge and unable to negotiate the scope further. Biopsies were taken from the tumour and histopathologically confirmed malignancy with mucinous adenocarcinoma. Chest X-ray (Fig. 1) was normal. Computed tomography (CT) of thorax, abdomen and pelvis revealed a circumferential heterogenouly enhancing mass involving distal transverse colon, splenic flexure and proximal part of descending colon (length of involved segment ~15cm); poor plane demarcation with greater curvature of the stomach, jejunum and tail of pancreas (Fig. 2). There was adjacent mesenteric fat streakiness and presence