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High jejunal perforation complicating tuberculous abdominal cocoon: a rare presentation in immune-competent male

M G Bani-Hani1, A Al-Nowfal, S Gould

  • 1North West London Hospitals NHS Trust, Northwick Park Hospital, Harrow, Middlesex, UK. mgbh76@hotmail.com

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|February 25, 2009
PubMed
Abstract

Insights

Tuberculosis (TB) peritonitis can rarely cause abdominal cocoons and multiple small-bowel perforations. Early anti-TB drugs and jejunostomy can aid healing in severe cases.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Tuberculosis peritonitis is an uncommon TB manifestation, often presenting insidiously with systemic symptoms and vague abdominal pain.
  • It predominantly affects the small bowel, frequently leading to obstruction and, rarely, an abdominal cocoon.
  • Perforation is an infrequent complication, typically involving the terminal ileum.

Observation:

  • This case report details multiple small-bowel perforations in an immunocompetent male patient with a TB cocoon.
  • The patient presented with a severe acute manifestation superimposed on an insidious TB cocoon.

Findings:

  • Tuberculosis cocoon, a rare form of TB peritonitis, usually presents as bowel obstruction.
  • However, TB can manifest as multiple bowel perforations, especially in children and the immunocompromised, carrying a high mortality rate.
  • Primary repair of TB perforation is hazardous but was necessary in this case.

Implications:

  • The increasing incidence of TB infections and multidrug-resistant strains may lead to more severe presentations.
  • Early anti-TB drug administration and proximal jejunostomy facilitated healing despite primary repair of TB perforations.
  • TB should be considered in atypical bowel perforation cases, with jejunostomy and early anti-TB treatment potentially aiding primary repair in aggressive infections.

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