INTESTINAL TUBERCULOSIS – A RARE CAUSE OF BOWEL PERFORATION beatrizcordeiro8@hotmail.com

PE026

INTESTINAL TUBERCULOSIS – A RARE CAUSE OF BOWEL PERFORATION

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Hugo Capote hugo.capote@ulsaale.min-saude.pt Unidade Local de Saúde do Alto Alentejo - Hospital Doutor José Maria Grande General Surgery Portalegre Portugal

Portugal

Oral or Poster

Although tuberculosis is primarily a respiratory disease, 20% of cases manifest as extrapulmonary tuberculosis, with 10% as intestinal tuberculosis (IT). Bowel perforation in IT is rare (4-7.6%), but has a high mortality rate (30%). IT diagnosis can be challenging leading to a delay in treatment. The case presented here illustrates the importance of an early diagnosis.

Case report and literature revision of intestinal perforation in IT.

52-year-old male patient with ankylosing spondylitis on methotrexate came to hospital with generalized abdominal pain. He had global abdominal tenderness and a WBC of 21690/uL and CRP of 270 mg/L. On CT, the patient had a pneumoperitoneum. During surgery, an ileal perforation was detected, with multiple small granulomatous lesions in the abdominal cavity. The perforation was treated with an ileostomy and a biopsy of the lesions was collected, that showed a sarcoid granulomatous disease. During his stay, the patient had a positive IGRA test, but with a negative Mycobacterium tuberculosis analysis in sputum. The patient was discharged with the diagnosis of sarcoidosis and latent tuberculosis. 3 months later the patient was admitted due to fever. In that admission, a pleural liquid analysis came positive for tuberculosis and the first peritoneal biopsies were reviewed coming back positive for IT. Despite starting appropriate treatment, the patient died from tuberculosis 6 months after the surgery.

This case highlights the importance of keeping in mind IT as a cause for bowel perforation, allowing for its early detection and treatment, thus preventing the high mortality associated.