Acute intestinal obstruction as the first manifestation of tuberculous peritonitis

Aim-Background

A case of dynamic ileus resulting from tuberculous peritonitis (TBP) is presented, which was treated with exploratory laparotomy and administration of antituberculosis therapy. TBP accounts for 0.1–0.7% of all cases of TB and usually presents as a subacute disease. Acute abdomen sometimes complicates TB, mainly because of intestinal perforation or obstruction.

Case presentation

A 20-year-old Pakistani male presented with symptoms and signs of intestinal obstruction. An exploratory laparotomy revealed ascites, small bowel distention due to adhesions around the terminal ileum, whitish nodules covering the inflamed peritoneum and omentum, enlarged mesenteric lymph nodes, and a saccular-shaped whitish mass measuring 11x7x5 cm at the right iliac fossa. Adhesiolysis, removal of the abovementioned mass, and an appendectomy was performed, and samples were obtained for microbiological and histological examination. The tuberculin skin test was positive, and since the intraoperative findings were highly suggestive of TBP, initiation of antituberculosis therapy on the 11th postoperative day was decided. Finally, the diagnosis of TBP was established both microbiologically and histologically. The patient successfully completed a 6-month regimen of antituberculosis drugs.

Conclusion

Acute abdomen necessitating exploratory laparotomy is a rare first manifestation of TBP. Early initiation of antituberculosis therapy should take place if intraoperative findings strongly favour the diagnosis of TBP.