Case report: Intestinal tuberculosis with perforation of the colon and psoas abscess associated with Escherichia coli ESBL

Introduction

Abdominal tuberculosis is the sixth most common form of extra-pulmonary tuberculosis. It manifests predominantly in four forms: tuberculous lymphadenopathy, peritoneal tuberculosis, intestinal tuberculosis and visceral tuberculosis. The perforation of the colon in intestinal tuberculosis is a complication which should be recognized, and treated surgically, as quickly as possible.

Clinical case

A 17-year-old female who was admitted with low back pain, limiting flexion of the thigh, fever, vaginal discharge, abdominal pain and weight loss. The CT scan showed a left tubo-ovarian abscess, pelvic cavity collection, reactive retroperitoneal lymph nodes, left psoas abscess and spondylodiscitis from L2 to L3. An exploratory laparotomy was performed, and we found a perforation in the cecum and ascending colon, left tubo-ovarian abscess, and a collection of fecal matter in the pelvic gap. We debrided and drained the left psoas collection, and performed a right hemicolectomy, an ileostomy, a transverse colon mucocutaneus fistula and a left salpingo-oophorectomy. The trans-operatory biopsy of the retroperitoneal adenopathy revealed a chronic granulomatous process compatible with tuberculosis. The Gram stain showed abundant polymorphonuclears and moderate Gram bacilli (−), and the BAAR stain was negative. The cultures showed Escherichia coli ESBL (Extended-spectrum beta-lactamases) sensitive to imipenem. Pathology reported chronic granulomatous salpingitis, chronic granulomatous peritonitis, and ulcerated and perforated cronic granulomatous colitis.

The patient was treated with broad-spectrum antibiotic therapy for tuberculosis.

Conclusion

With patients that present a perforation in an intestine with tuberculosis, their general condition should be evaluated, as well as their nutritional state and intestinal viability, before performing primary repair, resection and anastomosis or resection and bowel diversion surgery.