Dilemma in the Management of Concurrent Colonic Adenocarcinoma, Pulmonary Tuberculosis and Intestinal Tuberculosis: A Case Report

Tuberculosis usually affect respiratory system. However, up to 5% can present with abdominal manifestation and one of the common locations is in the ileocecal region. Ileocaecal tuberculosis and caecal tumour can be masquerading each other in term of their clinical presentations, endoscopic features and the appearances in CT scan. There are many reported cases where intestinal tuberculosis was misdiagnosed for a colon carcinoma and vice versa. The final diagnosis is usually either one of these and in almost all the cases, the diagnosis was confirmed post operatively based of histopathology report of the surgical specimen. With a single diagnosis, the management will be more straightforward. Management dilemma will arise when multiple pathology ie; caecal tumour, pulmonary tuberculosis and ileocaecal tuberculosis, diagnosed simultaneously in a patient with colonic symptoms that need early treatment. A structured management plan will be needed to treat all these conditions affectively and safely. We are presenting a challenging case of a concurrent colon carcinoma, pulmonary tuberculosis and intestinal tuberculosis which were diagnose in a single setting. With the involvement of multidisciplinary team, an ideal treatment strategy was structured and patient was managed successfully with a combination of surgical and medical treatment.