A 10 years old girl presented with pain abdomen, vomiting and fever since 5 days. There was history of abdominal tuberculosis about 2 years back and had also completed the course of anti-tubercular drugs. On examination, there was abdominal distension with severe diffuse tenderness with rigidity of the abdominal wall, suggestive of peritonitis. Erect X-Ray of the abdomen showed free gas under the diaphragm, suggestive of hollow viscus perforation. Patient was taken up for exploratory laparotomy after stabilization. Intraoperatively, there was gross feco-purulent collection in the peritoneal cavity with gross adhesions (probably as a result of the previous tuberculosis). A segment of descending colon was found to be strictured with dilatation and fecal loading of the large intestine proximal to the site of stricture. There was a large perforation on the strictured segment of descending colon. The descending colon was mobilized and the entire strictured segment (with the site of perforation), along with the proximally dilated part of transverse colon, were resected. On table bowel preparation was done to decrease the bacterial load and end to end anastomosis of the transverse colon with descending colon was done.
Patient improved uneventfully, enteral nutrition was started on 5th postoperative day and was discharged on 8th postoperative day.
Abdominal tuberculosis is known to cause intestinal strictures and internal fistulisation but perforation is supposed to be very rare.
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