Free Perforation of Ileal Tubercular Ulcer- A Case Report and Literature Review

Primary intestinal tuberculosis is unusual in North American, European and Caribbean countries. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. There is no reported case of ileal tubercular ulcer perforation from the Caribbean. We present a 59 year old HIV negative patient presented with peritonitis with solitary perforation of terminal ileum. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation and culture grew acid fast bacilli. A subsequent Manteaux test was strongly positive. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and it is now over one year, the symptoms have not recurs back again.