Acute Peritonitis: A Rare Complication Revealing Intestinal Tuberculosis - Acute Peritonitis: A Rare Complication Revealing Intestinal Tuberculosis - Open Access Pub

Intestinal tuberculosis diagnosis is often difficult because of non-specific symptoms, miming many other conditions such as malignancy, infectious disease, and inflammatory bowel disease. Free intestinal perforation is an uncommon but life-threatening complication of intestinal tuberculosis, associated with high morbidity and mortality. DOI10.14302/issn.2578-2371.jslr-19-3028 Intestinal tuberculosis diagnosis is often difficult because of non-specific symptoms, miming many other conditions such as malignancy, infectious disease, and inflammatory bowel disease. Free intestinal perforation is an uncommon but life-threatening complication of intestinal tuberculosis, associated with high morbidity and mortality. A 34-year-old alcohol-smoking manpresented to the emergency department with acuteepigastric pain, associated with fever. On examination, hisabdomen was diffusely tender with board-like rigidity, while digital rectal examination was painful. Laboratory investigations revealed inflammatory reaction (raised white blood cell, C-Reactive protein 140mg/l), associated with hypochromic anemia. Viral hepatitis serologies and HIV were negative. Abdomen and chest radiography showed pneumoperitoneum (Figure 1). Figure 1. Pneumoperitoneum on chest X Ray On emergency laparoscopy, there was purulent generalized peritonitis, without evidence of digestive perforation. Laparotomy was made, revealing twodistinct sites of ileum perforations 15cm from the ileocecal valve. There were strictures in the small intestine, with multiple mesenteric lymphadenitis.Ileocaecal resection and ileostomy were performed. Postoperatively the Patient had Uneventful Recovery The histopathologic examination of the resected bowel specimen showedcaseating granulomatous inflammation (Figure 2), consistent with intestinal small bowel tuberculosis complicated with peritonitis and perforation (Figure 3). The patient was started on anti-tuberculosis treatment. Figure 2. Epithelioid granuloma and giant cells (Arrow) with caseous necrosis (Star) Figure 3. Signs of acute peritonitis in the intestinal mucosa The histopathologic examination of the resected bowel specimen showedcaseating granulomatous inflammation (Figure 2), consistent with intestinal small bowel tuberculosis complicated with peritonitis and perforation (Figure 3). The patient was started on anti-tuberculosis treatment. Figure 2. Epithelioid granuloma and giant cells (Arrow) with caseous necrosis (Star) Figure 3. Signs of acute peritonitis in the intestinal mucosa Free perforations occur in 1 to 15% of patients with intestinal