A clinical dilemma: XXXX .

@entity1 @entity353 @entity233 @entity843 @entity1066 @entity1600 @entity344 @entity17289 @entity490 @entity382 @entity378 @entity1907
AIM: To evaluate the clinical, radiological and microbiological properties of @entity378 ( @entity378 ) and to discuss methods needed to get the diagnosis. METHODS: Thirty-one @entity1 diagnosed as @entity378 between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital, Istanbul, @entity233 were evaluated prospectively. Complete physical examination, medical and family history, blood count erythrocyte sedimentation rate, routine biochemical tests, Mantoux skin test, chest X-ray and abdominal ultrasonography (USG) were performed in all cases, whereas microbiological examination of @entity843 , upper @entity344 , colonoscopy or barium enema, abdominal tomography, mediastinoscopy, laparoscopy or laparotomy were done when needed. RESULTS: The median age of @entity1 (14 females,17 males) was 34.2 years (range 15-65 years). The most frequent symptoms were @entity490 and @entity353 . Eleven @entity1 had active @entity1907 . The most common abdominal USG findings were @entity843 and @entity382 . Ascitic fluid analysis performed in 13 @entity1 was found to be exudative and acid resistant bacilli were present in smear and cultured only in one @entity1 with BacTec (3.2 %). Upper @entity344 yielded nonspecific findings in 16 @entity1 . Colonoscopy performed in 20 @entity1 showed @entity1066 in 9 (45 %), nodules in 2 (10 %) and, stricture, polypoid lesions, granulomatous findings in terminal ileum and rectal fistula each in one @entity1 (5 %). Laparoscopy on 4 @entity1 showed dilated bowel loops, thickening in the mesentery, multiple @entity1066 and tubercles on the peritoneum. @entity1 with @entity378 were divided into three groups according to the type of involvement. Fifteen @entity1 (48 %) had intestinal @entity378 , 11 @entity1 (35.2 %) had @entity17289 and 5 (16.8 %) @entity1600 . The diagnosis of @entity378 was confirmed microbiologically in 5 (16 %) and histo-pathologically in 19 @entity1 (60.8 %). The remaining nine @entity1 (28.8 %) had been diagnosed by a positive response to antituberculous treatment. CONCLUSION: Neither clinical signs, laboratory, radiological and endoscopic methods nor bacteriological and histopathological findings provide a gold standard by themselves in the diagnosis of @entity378 . However, an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosis of this insidious disease which primarily necessitate a clinical awareness of this serious health problem.
