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Perforation peritonitis in primary intestinal tuberculosis.

R Sefr1, P Rotterová, J Konecný

  • 1Bakes Memorial Surgical Hospital, Brno, Czech Republic.

Digestive Surgery
|January 19, 2002
PubMed
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Primary intestinal tuberculosis can cause severe peritonitis and intestinal perforations, mimicking inflammatory bowel disease. Early recognition is crucial for timely treatment, even in patients without typical risk factors for tuberculosis.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Primary intestinal tuberculosis is rare in Western countries, often presenting diagnostic challenges.
  • Differentiating intestinal tuberculosis from inflammatory bowel diseases like Crohn's disease can be difficult.
  • Tuberculous perforation peritonitis is an uncommon but serious complication.

Observation:

  • A case of severe stercoral peritonitis due to multiple intestinal perforations from primary ileocecal tuberculosis is presented.
  • Initial presentation mimicked inflammatory bowel disease, leading to a suspected Crohn's disease diagnosis after colonoscopy and biopsy.
  • The patient required emergency surgery due to peritonitis, with the final diagnosis confirmed from the resection specimen.

Findings:

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  • The final pathological diagnosis confirmed primary intestinal tuberculosis as the cause of perforation and peritonitis.
  • Post-operative complications included subhepatic abscess formation requiring surgical drainage.
  • The patient recovered fully after antituberculotic therapy and is currently asymptomatic.

    • Implications:

    • Surgeons managing acute abdominal conditions must consider tuberculous perforation peritonitis, even in patients outside typical risk groups.
    • This case highlights the importance of considering tuberculosis in the differential diagnosis of intestinal perforations and peritonitis.
    • Awareness of this rare presentation is vital for appropriate and timely management in diverse patient populations.