Although abdominal TB can develop at any age, it is most common in patients between 25 and 45 years of age and females slightly predominate [
16]. Patients with gastroduodenal TB can present with obstruction or mass and an endoscopic biopsy has a poor yield [
4]. Gastric lesions typically cause dyspeptic complaints, and generally, peptic ulcer is suspected. If the patient has lost weight, in addition to these complaints, gastric cancer should be considered first [
17]. Gleason
et al. reviewed 49 patients with duodenal TB; they found that the most common presenting symptoms were pain (73 %) and vomiting (55 %), whereas GI bleeding was rare (16 %) [
18]. A report by Chetri
et al. described a case of gastric TB presenting as non-healing gastric ulcer and out of five cases, three presented with gastric outlet obstruction, which is the most common presentation of gastric TB [
19]. It may present as multiple shallow ulcers, especially on the lesser curvature of the stomach [
20], or as a nondescript hypertrophic submucosal mass [
21]. Another study showed that long-term therapy with H2 blockers increases the incidence of gastroduodenal TB [
22]. In investigations of patients, a chest X-ray may show evidence of pulmonary TB in up to 20 % of cases [
23] and upper GI endoscopy may reveal duodenal bulb deformity [
24]. Endoscopic biopsy has a poor yield even in ulcerated lesions and endoscopic biopsy rarely reveals granulomas because of the predominantly submucosal location of these lesions and the failure of routine endoscopic biopsies to include the submucosa [
17]. The diagnosis of duodenal TB is usually made after surgical intervention (exploratory laparotomy) and it is very rarely made preoperatively [
25]; however, Sharma
et al. reported that endoscopic ultrasonography (EUS) is an excellent modality for characterizing the lesion, as well as obtaining a sample for cytological confirmation of the diagnosis [
26]. Multiple intraoperative fine-needle aspiration cytology (FNAC) may be taken from the diseased portion of the duodenum to establish the histopathological diagnosis if not established by any other means [
7]. When the diagnoses of TB are established before surgery, most lesions regress with appropriate antitubercular treatment and do not require excision [
27,
28]. Minimally invasive procedures such as laparoscopic, endoscopic and percutaneous biopsy should be used for diagnosis of intraperitoneal TB as a first step in diagnosis, and laparotomy should be performed only when complications develop or diagnosis remains unclear in spite of these diagnostic modalities [
16]. Surgery is usually required for diagnosis or therapy, after which patients respond well to antituberculous treatment. In areas endemic for TB, a good biopsy from the site of gastroduodenal bleeding or mass lesion and the surrounding lymph nodes should always be obtained [
4]. In patients with gastric outlet obstruction, gastrojejunostomy is preferred over pyloroplasty, as intense fibrosis around the pyloroduodenal junction precludes safe pyloroplasty [
29]. Puri
et al. showed that endoscopic therapy in combination with antituberculous therapy is recommended as the first-line therapy for gastroduodenal TB and surgical intervention is reserved for the minority in whom endoscopic therapy fails [
30].