Abdominal Tuberculosis Complicated by Intestinal Perforation

Abstract

Although relatively rare, there is an increasing incidence of abdominal tuberculosis (TB) in the developed countries, with the peritoneum being the most common site of involvement. Manifestation of abdominal TB should be considered in patients with relevant clinical symptoms and risk factors, including a history of prior TB infection and residence in or travel to an area where tuberculosis is endemic. We report a case of intestinal tuberculosis with a complicated disease course after the completion of treatment. Persisting abdominal symptoms during or after treatment should raise suspicion of subclinical intestinal obstruction. Early clinical recognition and surgical treatment may avoid poor outcome due to intestinal perforation.

Figure 1

Ultrasound imaging reveals submucosal ileal wall thickening (a) (arrow) and free and loculated ascites (b) (arrow). Subsequent contrast-enhanced abdominal computed tomography showing ascites (asterix) and free air (arrow) in the peritoneal cavity in close relation to affected terminal ileum wall (c). Laparotomy showed many adhesions and focal omental thickening adhering to a thickened distal ileum loop cavity (d) (arrow).