Abdominal tuberculosis: an old disease surprising young doctors

Area of Science:

• Medicine
• Infectious Diseases
• Gastroenterology

Background:

• Tuberculosis (TB) is a global health issue, with extrapulmonary TB posing diagnostic challenges.
• Abdominal tuberculosis, the most common extrapulmonary site, presents with diverse clinical manifestations.
• Delayed diagnosis of atypical TB presentations can lead to severe complications.

Observation:

• A case of an adult woman presenting with bowel obstruction in the emergency department.
• Intraoperative findings suggested ovarian cancer with peritoneal dissemination.
• Histopathology revealed chronic granulomatous inflammation with acid-fast bacilli, confirming abdominal tuberculosis.

Findings:

• The patient was diagnosed with a rare tuberculous abdominal cocoon causing bowel obstruction.
• Initial treatment involved parenteral antituberculosis drug combination due to inability to tolerate oral feeding.
• Post-operative recovery was successful, with the patient asymptomatic at 5 months.

Implications:

• This case underscores the importance of considering tuberculosis in the differential diagnosis of acute abdomen, even with atypical presentations.
• Prompt diagnosis and appropriate antituberculosis therapy, including parenteral routes when necessary, are crucial for favorable outcomes.
• The rare "abdominal cocoon" presentation highlights the varied pathology of abdominal TB and the need for surgical intervention in obstructive cases.