Journal of Spleen and Liver Research
ISSN: 2578-2371
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Case Report | Open Access
  • Available online freely | Peer Reviewed
  • Acute Peritonitis: A Rare Complication Revealing Intestinal Tuberculosis

    Sabbah.M  1       Trad.D  1     Jemmali.C  1     Jouini R 1     Elloumi H 1     Bibani.N  1     Ouakaa.A  1     Gargouri.D  1    

    1Gastroenterology Department, Habib Thameur Hospital Tunis

    Abstract

    Intestinal tuberculosis diagnosis is often difficult because of non-specific symptoms, miming many other conditions such as malignancy, infectious disease, and inflammatory bowel disease.

    Free intestinal perforation is an uncommon but life-threatening complication of intestinal tuberculosis, associated with high morbidity and mortality.

    Received 13 Sep 2019; Accepted 25 Sep 2019; Published 30 Sep 2019;

    Academic Editor:Sunder Goyal, Department of Minimal Invassive and General Surgery, Kalpana Chawla Government Medical College, Haryana, India.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright©  2019 Sabbah.M, et al.

    License
    Creative Commons License    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Sabbah.M , Trad.D , Jemmali.C , Jouini R, Elloumi H et al. (2019) Acute Peritonitis: A Rare Complication Revealing Intestinal Tuberculosis. Journal of Spleen and Liver Research - 1(3):15-17.
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    DOI10.14302/issn.2578-2371.jslr-19-3028

    Introduction

    Intestinal tuberculosis diagnosis is often difficult because of non-specific symptoms, miming many other conditions such as malignancy, infectious disease, and inflammatory bowel disease.

    Free intestinal perforation is an uncommon but life-threatening complication of intestinal tuberculosis, associated with high morbidity and mortality.

    Case Report

    A 34-year-old alcohol-smoking manpresented to the emergency department with acuteepigastric pain, associated with fever.

    On examination, hisabdomen was diffusely tender with board-like rigidity, while digital rectal examination was painful.

    Laboratory investigations revealed inflammatory reaction (raised white blood cell, C-Reactive protein 140mg/l), associated with hypochromic anemia.

    Viral hepatitis serologies and HIV were negative.

    Abdomen and chest radiography showed pneumoperitoneum (Figure 1).

    Figure 1. Pneumoperitoneum on chest X Ray
    Figure 1.

    On emergency laparoscopy, there was purulent generalized peritonitis, without evidence of digestive perforation. Laparotomy was made, revealing twodistinct sites of ileum perforations 15cm from the ileocecal valve. There were strictures in the small intestine, with multiple mesenteric lymphadenitis.Ileocaecal resection and ileostomy were performed.

    Postoperatively the Patient had Uneventful Recovery

    The histopathologic examination of the resected bowel specimen showedcaseating granulomatous inflammation (Figure 2), consistent with intestinal small bowel tuberculosis complicated with peritonitis and perforation (Figure 3).

    The patient was started on anti-tuberculosis treatment.

    Figure 2. Epithelioid granuloma and giant cells (Arrow) with caseous necrosis (Star)
    Figure 2.

    Figure 3. Signs of acute peritonitis in the intestinal mucosa
    Figure 3.

    Discussion

    Free perforations occur in 1 to 15% of patients with intestinal tuberculosis and it is associated with mortality of about 30%. Factors linked with increased mortality were age, comorbidities, multiple perforations and delayed surgery.1

    The most common site of perforation is the terminal ileum -witch is our case- while the majority(90%) of perforations are solitary.2

    As surgical modality, the resection of the affected area and anastomosis may be the treatment of choice rather than primary closure.3

    Conclusion

    Perforation is a serious complication of intestinal tuberculosis. Only early surgical treatment can improve survival.

    References

    1.Lee M J, Cresswell F V, John L. (2012) Diagnosis and treatment strategies of tuberculous intestinal perforations. , EurJ GastroenterolHepatol 24, 594-599.
    2.Kakar A, Aranya R C, Nair S K. (1983) Acute perfortion of small intestine due to tuberculosis. , Aust NZJ Surg 53, 381-383.
    3.Ara C, Sogutlu G, Yildiz R. (2005) Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure. , JGastrointestSurg 9, 514-517.