A CASE OF PERFORATION OF THE LARGE INTESTINE DUE TO TUBERCULOUS PERITONITIS

Abstract

A 32-year-old man was admitted to the hospital because of lower abdominal pain, fever, and watery diarrhea. Colonoscopic fiber revealed solitary small ulcer in the sigmoid colon. High level of CRP persisted. CT was performed with a suspicion of inflammatory lesion around the large intestine, when abscess like low density area (LDA) was demonstrated in the Douglas' pouch. Barium enema study visualized a leakage of constrast medium from the wall of the sigmoid colon into abdomen. The patient was diagnosed as having peritonitis due to perforation of diverticulitis and was operated on. During surgery, the large intestine, small intestine, and omentum formed a mass, and small nodules existed on entier the serosa of abdominal cavity that looked like peritonitis carcinomatosis. Further, a retention of serous ascites was present in the Douglas' pouch that was coincident with the LDA on CT. Perforation of the sigmoid colon was confirmed, and a partial excision of the sigmoid colon and a biopsy of the omentum were performed. Histological study revealed that serosal side inflammation was severe at the perforated site but almost no inflammation in mucosa side. In the biopsied omentum and perforated site, foreign body granulation associated wit fat necrosis was noted. Cytologic diagnosis, anaerobic culture, and tuberculous smear test of the ascites were negative. The high CRP level still persisted after the operation. On 59 th postoperative day, we were reported that a culture and identification test for tubercle baccillus resulted in positive and tuberculostatic therapy was started. The patient was discharged from the hospital 113 days after the operation.