Multiple, large granulomas in a patient with extensive intestinal tuberculosis

Area of Science:

• Gastroenterology
• Infectious Diseases
• Abdominal Surgery

Background:

• Appendicitis is a common cause of acute abdomen.
• Abdominal tuberculosis can present with varied symptoms, sometimes mimicking other surgical emergencies.

Observation:

• A 42-year-old male presented with symptoms suggestive of acute appendicitis.
• Laparotomy revealed extensive masses in the terminal ileum, ascending colon, and enlarged mesenteric lymph nodes.
• Histopathology confirmed intestinal tuberculosis.

Findings:

• Right hemicolectomy was performed due to the extensive involvement.
• Post-operative empirical anti-tuberculosis treatment with a four-drug regimen was initiated.
• The patient showed marked improvement and remained asymptomatic at six months.

Implications:

• Highlights the importance of considering abdominal tuberculosis in the differential diagnosis of acute abdomen, especially in endemic areas.
• Demonstrates the efficacy of early surgical intervention followed by appropriate anti-tuberculosis therapy.
• Emphasizes the need for thorough pathological examination to differentiate between infectious and other causes of abdominal masses.