PICTURES IN DIGESTIVE PATHOLOGY

 

Non-surgical acute abdomen: intestinal tuberculosis

Abdomen agudo no quirúrgico: tuberculosis intestinal

 

 

S. López García, L. Alonso Fernández, M. Alvite Canosa and C. Gómez Freijoso

Service of General Surgery “A”. Complejo Hospitalario Universitario. A Coruña, Spain

 

 

Clinical case

This was a 21-year-old woman with nonspecific findings in her clinical history, who was operated on for abdominal pain with generalized peritonism, high fever, and severe leukocytosis.

No alterations were seen in her thorax.

The following was found during the procedure: turbid ascites and generalized peritoneal seeding, particularly in the terminal ileum.

A histological examination of biopsy samples revealed tuberculoid granulomas suggestive of miliary seeding.

The patient was treated for six months with three tuberculostatic drugs (isoniazid, rifampicin, pyrazinamide), and remains asymptomatic to this day.

Diagnosis: intestinal tuberculosis.

 

Discussion

We report a case illustrating the difficulty of diagnosing intestinal tuberculosis, especially when it affects an immunosuppressed patient without evidence of pulmonary disease. Generally speaking, the clinical presentation and complementary tests are nonspecific; in most cases, only a histopathological examination reveals the diagnosis (Figs. 1 and 2).

Recommended references

1. Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-VIH patients: an ongoing challenge for physicians. World J Gastroenterol 2006; 12(39): 6371-5.        [ Links ]

2. Haddad FS, Ghossain A, Sawaya E, Nelson AR. Abdominal tuberculosis. Dis Colon Rectum 1987; 30(9): 724-35 (Review).        [ Links ]

3. Schulze K, Warner HA, Murray D. Intestinal tuberculosis: experience at a Canadian teaching institution. Am J Med 1977; 63(5): 735-45.        [ Links ]