A Case of the Tuberculous Peritonitis that Developed Torsion of the Small Intestine

Tomofumi Osako, Kenji Okamura, Katsuhiko Inoue, Takeshi Taneda and Yuichiro Kawamura

The Department of Surgery, Labour Welfare Corporation Kumamoto Rosai Hospital

We report a case of tubercular peritonitis that developed into torsion of the small intestine. A 76-year-old woman noting periumbilical dull pain and slight fever from April 1999, was diagnosed with acute abdomen and referred for severe abdominal pain from the early morning on June 17, 1999. Abdominal computed tomography showed a spiral change in the small intestine around the mesenteric artery. We found fibrous cobweb-like adhesions throughout the abdominal cavity, causing torsion of the small intestine. During emergency surgery, we also found numerous millet-sized yellowish white nodules on the peritoneum, mesenterium, and intestinal serosa. Separation of the adhered intestine and removal of the torsion recovered intestinal color. Frozen sections showed epitheloid granuloma with caseous necrosis in this nodule and diagnosed it as tubercular peritonitis. We administered the same antituberculous agents as for pulmonary tuberculosis from postoperative day (POD) 7 and abdominal symptoms completely disappeared.

Key words
tuberculous peritonitis, torsion of the small intestine, acute abdomen

Reprint requests
Tomofumi Osako The Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital
1670 Takehara-cho, Yatsushiro, 866-8533 JAPAN

Accepted
March 24, 2004

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