Acute abdomen revealing abdominal tuberculosis complicated by a proximal jejunal perforation: Case report

Abstract

Abdominal tuberculosis (TB) remains a significant health concern globally, particularly in regions with high endemicity such as North Africa and Morocco. Despite advances in diagnostic modalities, the nonspecific presentation of abdominal TB poses challenges for timely diagnosis and management. Here, we report a case of abdominal TB in a critically state of a young man from Morocco, presenting with acute abdominal pain and signs of sepsis. Radiological investigations revealed features suggestive of intestinal perforation complicating peritoneal TB. Urgent laparotomy confirmed the diagnosis, yet the patient succumbed to advanced sepsis postoperatively. This case underscores the complexity of abdominal TB diagnosis and management, necessitating a high index of suspicion and multidisciplinary collaboration. With evolving surgical techniques and ongoing research efforts, optimizing strategies for early detection and treatment of abdominal TB remains imperative, particularly in endemic regions.

Keywords: Abdominal tuberculosis; CT scan; Gastro-intestinal tuberculosis; Intestinal perforation; Laparoscopic findings; Peritoneal tuberculosis.

Fig. 1

Axial image of an abdominal enhanced CT scan revealing an important pneumoperitoneum (asterisk) and multiples peritoneal masses with a scalloping effect on the liver (white arrow).

Fig. 2

Axial image of an abdominal enhanced CT scan revealing an important pneumoperitoneum (asterisk), a parietal defect in the jejunum in favor of a perforation (white arrow), and a thickened peritoneum with loculated ascites (head arrow).

Fig. 3

Axial image of an abdominal enhanced CT scan revealing pneumoperitoneum, a heterogenous lymphadenopathy with peripheral enhancement and a hypodense center (white arrow), and a thickened peritoneum with loculated ascites (head arrow).

Fig. 4

Image shows macroscopic laparotomy findings of duodenal mass with hyperemic and thickened peritoneum.

Fig. 5

Image shows macroscopic laparotomy findings of peritoneal tuberculosis with a thickened peritoneum and numerous millimetric white nodules in the omentum and the abdominal wall.

Fig. 6

Image shows macroscopic laparotomy findings of a jejunal perforation (head arrow) associated to peritoneal tuberculosis with a thickened peritoneum and tubercules.

Fig. 7

Microscopic histopathology image (x100): HE stained section showing areas of caseous necrosis associated with poorly formed epithelioid granulomas with multinucleated giant cells.

Fig. 8

Microscopic histopathology image (x400): HE stained section of poorly formed granuloma with Langhans type multinucleated giant.