Perforated tuberculous appendicitis: a rare case report

Abstract

Background

Gastrointestinal tuberculosis (TB) accounts for 3% of extrapulmonary TB. Tuberculous appendicitis is a rare type of abdominal TB and is seen in only 0.1%–0.3% of cases. Diagnosis is usually made after histopathologic examination of the appendectomy specimen. In Ethiopia, there had been no previous report of perforated appendicular TB, and to our knowledge, this is the first case report of a patient with perforated tuberculous appendicitis to be presented.

Case report

A 22-year-old male patient presented with complaints of severe abdominal cramp, periumbilical pain, nausea, 2 episodes of nonbilious vomiting, as well as high-grade fever. Upon admission, abdominal examination revealed direct tenderness below the umbilicus bilaterally and rebound tenderness over the right lower quadrant of the abdomen. The peritoneal cavity was opened through a lower midline incision, and a perforated appendix at the base was found.

Discussion

From the resected appendix, a sample biopsy was sent for histopathology, and the histological picture revealed granulomatous caseification lesion in the body of the appendix, but no granulomatous lesions elsewhere in the bowel or omentum. Based on these findings, the final diagnosis of perforated tuberculous appendicitis was made. After surgery, the patient started anti-TB treatment on the fourth postoperative day and continued therapy for 6 months, and marked clinical recovery has been observed to date.

Conclusion

Perforated tuberculous appendicitis was diagnosed only after histopathologic examination of the resected appendix. Hence, TB, a highly prevalent disease in low-income countries, should always be considered in patients with nonspecific abdominal clinical sign and symptoms. It is also suggested that all specimens from perforated appendicitis be subjected to histopathologic examination.

Keywords:

• tuberculous appendicitis
• perforated appendix
• histopathology
• resection
• nonspecific abdominal pain

Acknowledgments

We would like to thank our study subject for his consent of publication of this case report and any accompanying images. We also thank Mr Micheal Carandi (American Peace Corps volunteer, Ethiopia) and Mr Seifu Zeleke (English language instructor at Debre Berhan University, Ethiopia) for English language editing.

Disclosure

The authors report no conflicts of interest in this work.