Intestinal Tuberculosis Presenting as Massive Lower Gastrointestinal Bleeding: A Rare Presentation in Child

Background: Intestinal tuberculosis is a form of extra pulmonary tuberculosis that can involve any part of the gastrointestinal tract. It can present with nonspecific symptoms like chronic abdominal pain, anorexia, fatigue, fever, night sweats, weight loss, diarrhea, constipation, or blood in the stools. Acute presentation including intestinal obstruction and perforation have been reported in the literature; however massive lower gastrointestinal bleeding as one of the presenting symptom is rare. The management includes anti-tubercular drugs along with surgical intervention in acute presentation. Case characteristic: 11-year-old girl was admitted with complaints of fever and vague abdominal pain for one-week duration. Observation/intervention: The child was having recent weight loss, hypo albuminemia and strongly positive Manteaux test. Ultrasound abdomen revealed multiple pre and para aortic lymphadenopathy. The Computerised tomography (CT) guided biopsy from lymph node was planned but the child developed massive lower gastrointestinal bleeding which was managed surgically. Conclusion: The child underwent hemi-colectomy with ileostomy and intestinal tuberculosis was confirmed by biopsy. The patient was discharged home on anti-tubercular drugs with further follow up. Message: Intestinal tuberculosis should be considered as one of the differential diagnosis in a child presenting with massive lower gastrointestinal bleeding.