Complete Recovery Following Intestine Perforation Caused by Tuberculosis: A Case Report
DOI:
https://doi.org/10.53770/amhj.v5i4.788Keywords:
Intestinal Tuberculosis, Ileocaecal Perforation, Pneumoperitoneum, Extrapulmonary TuberculosisAbstract
Intestinal tuberculosis (ITB) can mimic common gastrointestinal disorders and is frequently diagnosed late, particularly in resource-limited settings where microbiological confirmation is unavailable. This case report aims to describe an unusual presentation of ITB as ileocaecal perforation and to highlight diagnostic and therapeutic considerations. The method used was a descriptive case report of a 25-year-old woman who presented with watery diarrhoea, vomiting, diffuse abdominal pain, fever, weight loss, and cough, and subsequently developed generalized peritonitis requiring emergency exploratory laparotomy. Intraoperative findings revealed an ileocaecal perforation requiring segmental resection with primary anastomosis. Histopathological examination of the resected bowel and regional lymph nodes demonstrated necrotising granulomatous inflammation with caseation and Langhans-type giant cells, supporting the diagnosis of ITB. Microbiological tests such as GeneXpert and culture were not performed due to resource limitations. Postoperatively, the patient received supportive care, antibiotics, and standard anti-tuberculosis therapy. The results showed a favorable clinical outcome, with no early postoperative complications, discharge on postoperative day seven, and complete symptom resolution with weight gain and radiological improvement at follow-up. This case illustrates that when microbiological confirmation is not feasible, histopathology combined with timely surgical intervention and anti-tuberculosis therapy can support diagnosis and lead to successful management of complicated ITB.
References
Almadi, M. A., Ghosh, S., & Aljebreen, A. M. (2009). Differentiating intestinal tuberculosis from Crohn's disease: A diagnostic challenge. American Journal of Gastroenterology, 104(4), 1003–1012. https://doi.org/10.1038/ajg.2008.162
Amarnath, S., Deeb, L., Philipose, J., Zheng, X., & Gumaste, V. (2021). A comprehensive review of infectious granulomatous diseases of the gastrointestinal tract. Gastroenterology Research and Practice, 2021, 8167149. https://doi.org/10.1155/2021/8167149
Barkun, A. N., Love, J., Gould, M., Pluta, H., & Steinhart, H. (2013). Bile acid malabsorption in chronic diarrhea: Pathophysiology and treatment. Canadian Journal of Gastroenterology, 27(11), 653–659. https://doi.org/10.1155/2013/485631
Debi, U., Ravisankar, V., Prasad, K. K., Sinha, S. K., & Sharma, A. K. (2014). Abdominal tuberculosis of the gastrointestinal tract: Revisited. World Journal of Gastroenterology, 20(40), 14831–14840. https://doi.org/10.3748/wjg.v20.i40.14831
Di Buono, G., Romano, G., Amato, G., Barletta, G., Romano, G., Adelfio, N., Geraci, G., & Agrusa, A. (2024). Surgical management of complicated abdominal tuberculosis: The first systematic review—New treatments for an ancient disease and the state of the art. Journal of Clinical Medicine, 13(16), 4894. https://doi.org/10.3390/jcm13164894
Ju, J., Liu, J., Dong, W., Zhong, Y., & Chu, H. (2025). Uncommon ileal perforation due to intestinal tuberculosis: A case report and literature review. Medicine, 104(1), e41099. https://doi.org/10.1097/MD.0000000000041099
Kedia, S., Das, P., Madhusudhan, K. S., Dattagupta, S., Sharma, R., Sahni, P., Makharia, G., & Ahuja, V. (2019). Differentiating Crohn's disease from intestinal tuberculosis. World Journal of Gastroenterology, 25(4), 418–432. https://doi.org/10.3748/wjg.v25.i4.418
Lewinsohn, D. M., Leonard, M. K., LoBue, P. A., Cohn, D. L., Daley, C. L., Desmond, E., Keane, J., Lewinsohn, D. A., Loeffler, A. M., Mazurek, G. H., O'Brien, R. J., Pai, M., Richeldi, L., Salfinger, M., Shinnick, T. M., Sterling, T. R., Warshauer, D. M., & Woods, G. L. (2017). Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: Diagnosis of tuberculosis in adults and children. Clinical Infectious Diseases, 64(2), 111–115. https://doi.org/10.1093/cid/ciw778
Malikowski, T., Mahmood, M., Smyrk, T., Raffals, L., & Nehra, V. (2018). Tuberculosis of the gastrointestinal tract and associated viscera. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 12, 1–8. https://doi.org/10.1016/j.jctube.2018.04.003
Nahid, P., Dorman, S. E., Alipanah, N., Barry, P. M., Brozek, J. L., Cattamanchi, A., Chaisson, L. H., Chaisson, R. E., Daley, C. L., Grzemska, M., Higashi, J. M., Ho, C. S., Hopewell, P. C., Keshavjee, S. A., Lienhardt, C., Menzies, R., Merrifield, C., Narita, M., O'Brien, R., Peloquin, C. A., ... Vernon, A. (2016). Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: Treatment of drug-susceptible tuberculosis. Clinical Infectious Diseases, 63(7), e147–e195. https://doi.org/10.1093/cid/ciw376
Rathi, P., & Gambhire, P. (2016). Abdominal tuberculosis. Journal of the Association of Physicians of India, 64(2), 38–47.
Ruan, Q. L., Yang, Q. L., Sun, F., Liu, W., Shen, Y. J., Wu, J., Jiang, N., Zhou, J. Y., Shao, L. Y., & Zhang, W. H. (2022). Recurrent pulmonary tuberculosis after treatment success: A population-based retrospective study in China. Clinical Microbiology and Infection, 28(5), 684–689. https://doi.org/10.1016/j.cmi.2021.09.022
Shah, H., Patel, J., Rai, S., & Sen, A. (2025). Advancing tuberculosis elimination in India: A qualitative review of current strategies and areas for improvement in tuberculosis preventive treatment. IJID Regions, 14, 1–5. https://doi.org/10.1016/j.ijregi.2024.100556
Shah, K. K., Pritt, B. S., & Alexander, M. P. (2017). Histopathologic review of granulomatous inflammation. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 7, 1–12. https://doi.org/10.1016/j.jctube.2017.02.001
Sharma, V., Soni, H., Kumar-M, P., Dawra, S., Mishra, S., Mandavdhare, H. S., Singh, H., & Dutta, U. (2021). Diagnostic accuracy of the Xpert MTB/RIF assay for abdominal tuberculosis: A systematic review and meta-analysis. Expert Review of Anti-Infective Therapy, 19(2), 253–265. https://doi.org/10.1080/14787210.2020.1816169
Tadese, Z. B., Arage, F. G., Tsegaw, T. K., Alemu, E. A., Abate, T. G., & Taye, E. A. (2025). Forecasting tuberculosis in Ethiopia using deep learning: Progress toward sustainable development goal evidence from global burden of disease 1990–2021. BMC Infectious Diseases, 25, 870. https://doi.org/10.1186/s12879-025-11228-3
Tahiri, M., Goh, K. L., Abbas, Z., Epstein, D., Min-Hu, C., Mulder, C. J. J., Puri, A. S., Schultz, M., LeMair, A., & Melberg, J. (2023). Digestive tract tuberculosis guideline. Journal of Clinical Gastroenterology, 57(7), 643–650. https://doi.org/10.1097/MCG.0000000000001819
Tobin, E. H., & Khatri, A. M. (2025). Abdominal tuberculosis. Treasure Island: StatPearls Publishing.
Weledji, E. P., & Pokam, B. T. (2017). Abdominal tuberculosis: Is there a role for surgery? World Journal of Gastrointestinal Surgery, 9(8), 174–181. https://doi.org/10.4240/wjgs.v9.i8.174
WHO. (2024). Global tuberculosis report 2024. Geneva: WHO. Retrieved from https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024
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