Related Experiment Video
Updated: May 17, 2025
A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients
Published on: October 25, 2024
Uncommon ileal perforation due to intestinal tuberculosis: A case report and literature review
Jianhua Ju1, Jingyu Liu1, Wei Dong1
1Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, China.
Rationale:
Tuberculosis (TB) is a chronic granulomatous infectious disorder, caused by Mycobacterium tuberculosis. Extrapulmonary TB, which accounts for 20% of cases, includes intestinal TB in 10%. Gastrointestinal TB leads to intestinal perforation in 4% to 7.6% of cases, with a mortality rate of 30%.
Patient Concerns:
We conducted a retrospective analysis of a patient with ileal perforation due to intestinal TB. A male in his early 20s (initial weight, 35 kg) presented with a 2-day history of abdominal pain, exhibiting tenderness, rebound tenderness, and muscular guarding upon physical examination. Computed tomography (CT) imaging revealed a significant amount of free gas and fluid in the abdominal cavity. Subsequently, the patient underwent ileal repair and ileostomy.
Diagnoses:
Histopathological examination confirmed multifocal amorphous pink caseating necrotic material and Langhans giant cells in the mesenteric lymph nodes. A polymerase chain reaction (PCR) assay confirmed infection with M tuberculosis.
Interventions:
On the 20th postoperative day, enteral nutrition was initiated concomitantly with antitubercular therapy (ATT). After 1 month, enteral nutrition and oral diet were alternated for 2 months, then changed to oral diet alone, and the patient was discharged to continue ATT. Five months later, the patient's weight increased by 20 kg, and he began exercising outdoors. The patient underwent a successful ostomy reversal.
Outcomes:
At the 12-month follow-up, his body weight had increased to 65 kg, PCR testing was negative for M tuberculosis, and antituberculosis drugs were discontinued.
Lessons:
This case highlights the successful management of ileal perforation due to intestinal TB with peritonitis, without complications such as fistulas. Diagnosis of small bowel perforations due to intestinal TB remains challenging even for experienced clinicians, and surgical approaches are controversial. We emphasized the significance of diagnostics of such cases and often requiring a multidisciplinary approach involving various medical teams.
Related Concept Videos
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...