Isolated jejunal tuberculosis presenting as chronic intestinal obstruction

Intestinal tuberculosis (TB) most commonly involves the ileo-caecal region. Isolated involvement of the jejunum without concomitant ileo-caecal or colonic disease is exceptionally rare. We report the case of a woman in her early 60s who presented with a 2-year history of postprandial abdominal pain, intermittent constipation, anorexia and weight loss, followed by acute-onset vomiting suggestive of small bowel obstruction. Contrast-enhanced CT demonstrated a short-segment jejunal stricture with proximal dilatation. Enteroscopy confirmed luminal narrowing. Ileo-colonoscopy showed no ileo-caecal involvement. The patient underwent laparoscopy-assisted segmental jejunal resection. Histopathology revealed necrotising epithelioid granulomatous inflammation consistent with TB. Cartridge-based nucleic acid amplification test (GeneXpert MTB/RIF assay system, Cepheid, Sunnyvale, California, USA) was negative. She was commenced on standard antitubercular therapy with a good clinical response. This case highlights the importance of considering TB in isolated small bowel strictures in endemic regions, even in the absence of ileo-caecal disease or systemic features.