A Case Report on Non-typical Findings of Small Intestinal Perforation Caused by Tuberculosis

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  • 非特異的な微小病変で発症した二次性小腸結核穿孔の1例
  • 症例 非特異的な微小病変で発症した二次性小腸結核穿孔の1例
  • ショウレイ ヒトクイテキ ナ ビショウ ビョウヘン デ ハッショウ シタ ニジセイ ショウチョウ ケッカク センコウ ノ 1レイ

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Abstract

An 86-year-old man with a history of hemodialysis and diabetes mellitus was admitted to our hospital for sudden abdominal pain. Abdominal computed tomography (CT) revealed free air and wall thickening in part of the small intestine, while chest CT showed many small nodules in the bilateral lungs, suggestive of bronchial pneumonia. Emergency laparotomy revealed a perforation site, 1 mm in diameter, in the small intestine as well as many small white nodules on the mesenterium. Under a tentative diagnosis of idiopathic perforation, partial resection of the small intestine was performed. Histopathological examination showed tuberculosis of the intestine ; polymerase chain reaction (PCR) tests of patient sputum samples were also positive for Mycobacterium tuberculosis DNA. Based on these findings, the patient was also diagnosed with secondary intestinal tuberculosis leading to perforation. Although perforation caused by intestinal tuberculosis is rare, it should be included in differential diagnosis for intestinal perforation, especially in immunity-impaired patients, even if it is not considered a typical tuberculosis finding.

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