Primary tubercular caecal perforation: a rare clinical entity

We report the case of a 39 year old male who presented with features of perforation peritonitis, which on laparotomy revealed a caecal perforation with a dusky appendix. A standard right hemicolectomy with ileostomy and peritoneal toileting was done. Histopathology revealed multiple transmural caseating granulomas with Langerhans-type giant cells and acid-fast bacilli, consistent with tuberculosis, present only in the caecum.We report this extremely rare presentation of primary caecal tuberculosis to sensitize the medical fraternity to its rare occurrence, which will be of paramount importance owing to the increasing incidence of tuberculosis all over the world, especially among the developing countries.Intestinal tuberculosis is an extremely common occurrence in India. Any portion of the gastrointestinal tract may be affected by it, and various pathogenic mechanisms are involved. However, a primary isolated caecal perforation due to tuberculosis is an unusual occurrence, without the concomitant involvement of the ileum or ascending colon. We report this extremely rare presentation, the diagnosis of which was made retrospectively, with a view to sensitize the entire world to this entity.A 39 year old male presented to the emergency department, in the month of May 2009, with complaints of right lower quadrant abdominal pain and low grade fever of 2 days duration. He was a chronic alcoholic since 10 years and had no other significant prior medical, surgical history, or any evidence of a traumatic event. On examination, the patient had tachycardia, and slight tenderness and guarding, localized to the right iliac fossa. The rest of the abdomen was non tender. His routine blood tests were within normal limits, with completely normal counts. His HIV and HBsAg tests were negative. An x ray of his abdomen (erect film) showed a ground glass appearance. Ultrasound examination of his abdomen however revealed features suggestive of terminal ileitis or ruptured appendix (caecal