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Tuberculous peritonitis after conservative treatment for acute perforated appendicitis: a case report
Satoru Tanoue1, Yuki Ohya2, Osamu Nakahara1,3
1Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro, Kumamoto, 866-8533, Japan.
Background:
Interval appendectomy is widely recommended for patients with abscesses due to perforated appendicitis. A concomitant malignancy-related problem was reported after conservative treatment of acute appendicitis with abscess, but perforated appendicitis-associated tuberculous peritonitis was never reported.
Case Presentation:
A 67-year-old male patient with a laryngeal cancer history presented to our hospital with an acute appendicitis-associated ileal abscess. He was scheduled for an interval appendectomy after conservative treatment. Fortunately, the symptoms subsided, and the patient was discharged for a later scheduled appendectomy. However, after 3 months, he was readmitted to our hospital with fever and abdominal pain, and emergency surgery was performed, which was suspected to be peritonitis. Intraoperative results revealed numerous white nodules in the abdominal cavity. The condition was diagnosed as tuberculous peritonitis based on macroscopic results, later pathological findings, and positive T-SPOT.TB. The antituberculosis medications were effective, and the patient recovered and was discharged from the hospital 8 days thereafter.
Conclusion:
Patients, particularly those immunocompromised, may develop tuberculous peritonitis after conservative treatment for acute perforated appendicitis.
Insights
Tuberculous peritonitis is a rare complication that can occur after conservative treatment for perforated appendicitis, especially in immunocompromised patients. Early diagnosis and antituberculosis medication are crucial for recovery.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Interval appendectomy is standard for perforated appendicitis with abscess.
- Malignancy complications are known after conservative appendicitis treatment.
- Tuberculous peritonitis following perforated appendicitis has not been previously reported.
Purpose of the Study:
- To report a rare case of tuberculous peritonitis.
- To highlight a potential complication of conservative perforated appendicitis treatment.
Main Methods:
- Case presentation of a 67-year-old male with laryngeal cancer history.
- Initial conservative treatment for appendicitis-associated ileal abscess.
- Subsequent diagnosis of tuberculous peritonitis via intraoperative findings, pathology, and T-SPOT.TB.
- Treatment with antituberculosis medications.
Main Results:
- Patient initially improved with conservative treatment for appendicitis.
- Readmission occurred with symptoms suggestive of peritonitis.
- Diagnosis of tuberculous peritonitis confirmed during emergency surgery.
- Successful recovery following antituberculosis treatment.
Conclusions:
- Tuberculous peritonitis can be a delayed complication of perforated appendicitis.
- Immunocompromised individuals may be at higher risk.
- Conservative management of appendicitis abscesses requires vigilance for unusual complications.
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