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[A case of perforative peritonitis complicated with lung and intestinal severe tuberculosis]
Fuminobu Kuroda1, Takenori Yagi, Fumio Yamagishi
1Department of Chest Medicine, School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan. fkuroda@insei.m.chiba-u.ac.jp
Abstract:
A 27-year-old man was admitted to our hospital in September 18, 2000, complaining of fever, cough, appetite loss and body weight loss. He was diagnosed as advanced lung tuberculosis, because of chest X-ray findings and positive acid-fast bacilli in his sputum. He was administrated rifampicin (RFP), isoniazid (INH) and ethambutol (EB). Two days after starting treatment he complained of abdominal pain and the signs of perforating peritonitis. Emergency laparotomy was performed and we observed multiple ulcers and a perforation of ileum. We resected a part of distal ileum and ascending colon and made ileostomy. Histopathologic examination of resected ileum and colon showed multiple ulcers and epithelioid cell granulomas with caseous necrosis. Many acid bacilli were identified from the lesion by specially stained tissue sections. He was administrated streptomycin and INH by injection post-operatively while oral administration was impossible. Six days after the first operation, we found the signs of perforation in another part of the ileum. So we were obliged to perform second laparotomy and resect the part involved. Five days after the second operation, he was able to take RFP, INH, and levofloxacin per oral route. On February 8, 2001 we performed ileocolonal reconstruction with side to side anastomosis and closed ileostomy at the third laparotomy. He had continued chemotherapy and went back to Korea in April 7, 2001. Although intestinal tuberculosis has sharply declined in Japan thanks to development of effective antituberculous drugs, we should keep in mind that it could be a possible cause of the acute abdomen.
Insights
This case study highlights a rare instance of intestinal tuberculosis presenting as acute abdomen. Early diagnosis and prompt surgical intervention are crucial for managing this severe complication of tuberculosis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Abdominal Surgery
Background:
- Tuberculosis (TB) primarily affects the lungs, but extrapulmonary manifestations can occur.
- Intestinal tuberculosis (ITB) is a less common form, often presenting with vague symptoms, delaying diagnosis.
Observation:
- A 27-year-old male presented with advanced lung tuberculosis and subsequently developed acute abdominal pain.
- Emergency laparotomy revealed ileal perforation and multiple ulcers, necessitating resection and ileostomy.
- Histopathology confirmed intestinal tuberculosis with epithelioid granulomas and acid-fast bacilli.
Findings:
- The patient required two subsequent laparotomies due to further intestinal perforations.
- Successful management involved a combination of surgical interventions and multi-drug anti-tuberculosis chemotherapy.
- Ileocolonic reconstruction and ileostomy closure were performed in a third laparotomy.
Implications:
- Intestinal tuberculosis, though declining, remains a critical differential diagnosis for acute abdomen, especially in endemic areas.
- Aggressive management combining surgery and chemotherapy is vital for favorable outcomes.
- Awareness among clinicians is essential for timely recognition and treatment of ITB complications.