Lower gastrointestinal bleeding as a rare manifestation of small bowel and colon tuberculosis: a case report

Tuberculous enteritis (TE) is an exceptionally rare cause of lower gastrointestinal (GI) bleeding, especially in elderly patients. Its clinical presentation can mimic more common conditions such as diverticular disease, malignancy, or inflammatory bowel disease, making early diagnosis challenging. This case concerns an 89-year-old female patient who was transferred from the Internal Medicine Department to our clinic due to persistent lower GI bleeding. The patient underwent two gastroscopies, which revealed no significant findings, and two colonoscopies. The first colonoscopy showed diverticula in the descending colon, while the second identified a 1 cm ulcer with a whitish coating in the transverse colon. A computed tomography (CT) scan revealed pulmonary consolidation, atelectasis, and intraperitoneal fluid, along with sigmoid diverticula. Due to ongoing hemodynamic instability, the patient underwent urgent subtotal colectomy and terminal ileostomy. Intraoperative findings included blood clots filling the ileum and colon, wall thickening, multiple diverticula, and ascitic fluid. Histopathological analysis confirmed tuberculosis (TB) with the presence of epithelioid granulomas.