A 28-year-old man from northern India presents with chronic abdominal pain, evening rise of temperature, and weight loss. Barium study shows narrowing of the ileocaecal region with a shrunken caecum pulled up out of the pelvis. Biopsy shows confluent granulomas with central caseation and acid-fast bacilli. The most likely diagnosis is:
- A Ileocaecal tuberculosis ✓
- B Crohn's disease
- C Caecal carcinoma
- D Yersinia enterocolitica ileitis
Correct answer: A. Ileocaecal tuberculosis
Explanation
Caseating granulomas with demonstrable acid-fast bacilli confirm intestinal tuberculosis, which characteristically involves the ileocaecal region owing to abundant lymphoid tissue and physiological stasis there. The pulled-up, shrunken caecum results from fibrosis and shortening of the mesocaecum. Crohn's shows non-caseating granulomas without organisms, Yersinia causes self-limiting ileitis, and caecal carcinoma would present as a mass lesion rather than diffuse inflammatory narrowing.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.