Publication:

A rare complication of the great mimicker: free tubercular ileal perforation

Primary intestinal tuberculosis is an uncommon form of extra-pulmonary tuberculosis. With non-specific manifestations, unusual presentations and no proven superior diagnostic modality, differentiation and diagnosis of abdominal tuberculosis is a difficult scenario. Undiagnosed, untreated cases may present with complications. Free perforation of small bowel due to tuberculosis is a rare complication (1-2%) because of adhesion formation and reactive peritoneal thickening; however, when it occurs is most feared for its association with high mortality. We report a case of an elderly male who presented with features of intestinal perforation, treated with emergency surgery and diversion ostomy for small bowel perforation which was diagnosed post-operatively to be of tubercular etiology. Acute care surgeons may be trapped in diagnosing such cases with its non-specific imaging findings, and hence must maintain a low threshold for surgical intervention in the emergency setting.