[A case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis]

We report here a case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis. An 89-year-old woman, who had been treated for tuberculous spondylitis and operated for tuberculous mastitis and peritonitis, was transferred to our hospital with high grade fever, lower abdominal pain and vomiting. An enhanced abdominal computed tomography (CT) revealed ascites and hypertrophy of the parietal peritoneum. Puncture and drainage of ascites were performed and revealed that a smear examination of the specimen was positive for acid-fast bacilli (Gaffky 1). Treatment by rifampicin, isoniazid and ethambutol for tuberculous peritonitis was started then halted because of drug-induced liver injury. After recovery of the liver damage improved, anti-tuberculosis drugs (rifampicin and streptomycin) were restarted. However two days after recommencing administration, repeated vomiting occurred. An abdominal X-ray showed intestinal obstruction. An ileus tube was inserted and she was treated conservatively, but her symptoms did not improve. Injection of contrast medium through the ileus tube showed obstruction of the upper jejunum, so open surgery was performed. Disseminated yellowish miliary tubercles were seen on the peritoneum and severe inflammatory adhesions were found between the jejunum and the ileum. After ablation of the adhesions, partial resections of jejunum and ileum were performed. Histological examination confirmed the diagnosis of tuberculous peritonitis.