Perforated Ileum Secondary to Gastrointestinal Tuberculosis

Objective: To describe the unusual findings of an exploratory laparotomy for nonspecific acute surgical abdomen. Outcome: 50-year-old male drug user (cocaine, crack, marijuana) with an acute surgical abdomen compatible with uncomplicated appendicitis. The leukogram showed white blood cells at 15,4 x 10³/µl and granulocytes at 12,0 x 10³/µl. Emergency exploratory laparotomy revealed thickening of the ileum with inflammatory changes, erythematous with granulomatous appearance and perforation at 50 cm of the ileocecal valve. The biopsy of the specimen sent reported foci of granulation related to the perforation area, Langhans-type multinucleated giant cells peripheral to an area of necrosis with a caseous appearance and histiocytic epithelioid cells compatible with the diagnosis of tuberculosis. Discussion: Intestinal tuberculosis and its complications, even in tuberculosis endemic regions, are not a common finding. In countries with extremely limited diagnostic resources, it is the clinical manifestations that guide the initial management, so histopathological studies are necessary for a definitive diagnosis