Uncommon ileal perforation due to intestinal tuberculosis: A case report and literature review

Abstract

Rationale: Tuberculosis (TB) is a chronic granulomatous infectious disorder, caused by Mycobacterium tuberculosis. Extrapulmonary TB, which accounts for 20% of cases, includes intestinal TB in 10%. Gastrointestinal TB leads to intestinal perforation in 4% to 7.6% of cases, with a mortality rate of 30%. Patient concerns: We conducted a retrospective analysis of a patient with ileal perforation due to intestinal TB. A male in his early 20s (initial weight, 35 kg) presented with a 2-day history of abdominal pain, exhibiting tenderness, rebound tenderness, and muscular guarding upon physical examination. Computed tomography (CT) imaging revealed a significant amount of free gas and fluid in the abdominal cavity. Subsequently, the patient underwent ileal repair and ileostomy. Diagnoses: Histopathological examination confirmed multifocal amorphous pink caseating necrotic material and Langhans giant cells in the mesenteric lymph nodes. A polymerase chain reaction (PCR) assay confirmed infection with M tuberculosis. Interventions: On the 20th postoperative day, enteral nutrition was initiated concomitantly with antitubercular therapy (ATT). After 1 month, enteral nutrition and oral diet were alternated for 2 months, then changed to oral diet alone, and the patient was discharged to continue ATT. Five months later, the patient’s weight increased by 20 kg, and he began exercising outdoors. The patient underwent a successful ostomy reversal. Outcomes: At the 12-month follow-up, his body weight had increased to 65 kg, PCR testing was negative for M tuberculosis, and antituberculosis drugs were discontinued. Lessons: This case highlights the successful management of ileal perforation due to intestinal TB with peritonitis, without complications such as fistulas. Diagnosis of small bowel perforations due to intestinal TB remains challenging even for experienced clinicians, and surgical approaches are controversial. We emphasized the significance of diagnostics of such cases and often requiring a multidisciplinary approach involving various medical teams.