Recurrent small intestinal perforations during anti-tuberculous treatment

Abstract

Spontaneous intestinal perforation due to tuberculous (TB) enteritis is rare, occurring in 1–15%. Much rarer are TB intestinal perforations among patients receiving their course of anti-TB treatment. This is the so-called paradoxical response phenomenon, e.g., the occurrence of clinical or radiological worsening of pre-existing TB lesions, or the development of new lesions not attributable to the normal course of the disease in a patient who initially improves from the anti-TB treatment. A 52-year-old male patient with three episodes of spontaneous small intestinal perforations in a span of 4.5 months while receiving anti-TB treatment is presented here and the intraperitoneal changes in each operation documented. On each occasion, he recovered uneventfully after resection of the involved segment of intestine. The pathological examination of the resected segments of bowel in the second and third operations failed to show remnant TB granuloma. Seven months after his last operation, he resumed his normal work routine and completed his TB treatment without further medical mishap. The number of spontaneous intestinal perforations in such a paradoxical response phenomenon does not appear to have any bearing on his prognosis for cure of the disease.