CASE 11367 Published on 05.12.2013
0

Tuberculous peritonitis and enteric fistula

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Dorovskikh Galina, Sedelnikov Sergey, Gorlina Ann

Omsk Emergency Hospital No.1,
Radiology dep.;
9, ul. Pereleta Omsk,
Russian Federation;
Email:gal-dorovskikh@yandex.ru
Connected authors
Galina Dorovskikh RUSSIAN FEDERATION
Patient

28 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT
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Clinical History
28-year-old, male.
Abdominal fistula in mesogastric area, subfebrile temperature, slight abdominal pain.
The patient was treated for haematogenous disseminated pulmonary tuberculosis, had a positive probe result for Mycobacterium tuberculosis from the respiratory tract.
Three months earlier, the patient was operated on for a perforated ulcer of the small intestine.
Imaging Findings
MDCT of abdomen with oral contrast, 3 hours before the study, to determine the localization of the fistula; MDCT of abdomen with injection of contrast agent was performed (OMNIPAQUE-350 100 ml).
MDCT findings:
-multiple encapsulated liquid collections with gas bubbles between the intestinal loops, in the pelvic cavity and retroperitoneal
-hyperplasia of the mesenteric lymph nodes
-enteric fistula
-signs of disseminated pulmonary tuberculosis
Discussion
Tuberculous peritonitis is a rare disease [1]. Tuberculous peritonitis is caused by lymphogenous haematogenous dissemination of Mycobacterium tuberculosis, or by the contact way - the transition from the intestine to the visceral peritoneum (for example, perforation of the intestine ulcers). This presentation shows a case of tuberculous peritonitis with the presence of enteric fistula, discussed radiographic patterns of change abdominal cavity and retroperitoneal space, which can be useful in the diagnosis of this rare disease.
Treatment: laparotomy, excision of enteric fistula and interintestinal adhesions, removal of liquid formations of the abdomen and pelvis, mesenteric lymph node biopsy. The further treatment of tuberculosis should take place in a specialized clinic.
MDCT is a high-sensitive and effective method to estimate the prevalence and forms of tuberculosis. MDCT with contrast enhancement, in this case, helps to identify the nature changes in the abdominal cavity, and avoid unnecessary surgery.
Differential Diagnosis List
intestinal tuberculosis, tuberculous peritonitis, enteric fistula.
Ovarian carcinoma [2
3]
Peritoneal carcinomatosis [4]
T cell lymphoma [5]
Final Diagnosis
intestinal tuberculosis, tuberculous peritonitis, enteric fistula.
Case information
URL: https://www.eurorad.org/case/11367
DOI: 10.1594/EURORAD/CASE.11367
ISSN: 1563-4086
Figure 1

MDCT + contrast agent (oral and intravenous)

MDCT + contrast agent (oral and intravenous)
Multiple encapsulated liquid collections (green arrows) with gas bubbles between the intestinal loops, in the pelvic cavity and retroperitoneal. Hyperplasia of the mesenteric lymph nodes.
Figure 2

MDCT + contrast agent (oral and intravenous)

MDCT + contrast agent (oral and intravenous)
Multiple encapsulated liquid collections (green arrow) with gas bubbles between the intestinal loops, in the pelvic cavity and retroperitoneal. Enteric fistula.
Figure 3

MDCT + contrast agent (oral and intravenous)

MDCT + contrast agent (oral and intravenous)
Enteric fistula (green and red arrow). Signs of disseminated pulmonary tuberculosis