Intestinal tuberculosis complicated with perforation in an immunocompetent patient: Case report and review of the literature

Abstract

Introduction: Intestinal tuberculosis (ITB), a rare yet severe manifestation of Mycobacterium tuberculosis infection, poses significant diagnostic and therapeutic challenges due to its nonspecific clinical presentation. Perforation, a life-threatening complication, necessitates prompt surgical intervention and effective antituberculous therapy. Case presentation: This case study highlights a 41-year-old immunocompetent male who presented with fever, abdominal pain, vomiting, and significant weight loss. A computed tomography scan revealed minimal pneumoperitoneum, intestinal wall thickening, mesenteric fat stranding, lymphadenopathy, and an intra-abdominal abscess. Exploratory laparotomy identified a perforation at the terminal ileum, leading to ileocaecal resection and stoma formation. Histopathological examination confirmed ITB, and a nine-month regimen of antituberculous medication was initiated. Discussion: ITB, more common in immunocompromised individuals, can also affect immunocompetent patients, often mimicking other gastrointestinal conditions and delaying diagnosis. This case underscores the importance of considering ITB in differential diagnoses for patients with vague gastrointestinal symptoms. Diagnostic confirmation typically requires a combination of clinical, radiological, and microbiological assessments, with histopathology playing a crucial role. Factors such as age and comorbidities can increase the risk of severe complications like perforation. Surgical resection with anastomosis tends to yield better outcomes than direct closure, and comprehensive antituberculous therapy is essential for successful treatment. Conclusion: The complexity of diagnosing and managing ITB, compounded by its severe complications, necessitates heightened awareness among healthcare providers. Accurate diagnosis, timely surgical intervention, and rigorous antituberculous therapy are vital for improving patient outcomes, especially in high-risk populations or regions with prevalent TB.

Keywords

• Intestinal tuberculosis
• Mycobacterium tuberculosis
• Perforation
• Abdominal tuberculosis