Acute adomen in a transplant patient with tuberculous colitis: a case report

Abstract

Introduction: Tuberculous colitis is a rare form of tuberculosis and is found in immunosuppressed patients, usually with the clinical appearance of Crohn's disease. The purpose of this article is to report a rare case of tuberculous colitis in a transplant patient, presenting in the form of bowel obstruction and acute abdomen.

Methods: A male patient, 51 years old, with a history of kidney transplant in a foreign country 19 months before, presented at the emergency department, after being referred by a primary care center, with obstipation during the previous week and acute abdominal pain. The patient had the clinical appearance of acute abdomen. Five days before the patient underwent colonoscopy, which revealed an intraluminal mass that partially occluded the lumen of the ascending colon. Blood tests revealed a mildly elevated WBC count and anaemia. Imaging studies revealed air in the peritoneal cavity and free fluid in the pelvis. The patient was diagnosed with perforation of a hollow viscus and was admitted for surgery

Results: During laparotomy the findings were a perforation of the cecum, a fragile mass (pseudopolyp), which occluded the lumen approximately in the middle of the ascending colon, diffuse erosions of the mucosa and pseudomembranes. A bezoar was found impacted at the level of the occlusion. There was also marked lymph node enlargement in the mesentery and ischaemia of the cecum. A typical right hemicolectomy was performed and special care was taken so, as not to damage the renal transplant. The pathological and microbiological (from free peritoneal fluid) investigation suggested the diagnosis of tuberculous colitis. Further blood tests and respiratory investigation confirmed the diagnosis of active tuberculosis, with the colon as a primary site. The patient received the appropriate antituberculous treatment.

Conclusions: Tuberculous colitis is a rare form of tuberculosis and is found in immunosuppressed patients. Deferential diagnosis from other forms of colitis is usually problematic. Tuberculous colitis rarely manifests itself in the form of acute surgical abdomen. The possible diagnosis of tuberculous colitis must be always in mind when treating transplant patients.

Figure 1

Colonoscopic image of the patient. Intraluminal mass, partially occluding the lumen of the ascending colon.