Primary caecal tuberculosis with perforated caecum: A case report

Background: Intestinal tuberculosis is a common type of extrapulmonary tuberculosis in endemic regions that carries significant morbidity and mortality due to its serious abdominal complications. Case description: This report presents the case of a 16-year-old girl who was presented with features of ruptured appendix, which on laparotomy found to have isolated caecal perforation. A limited right hemicolectomy with end-to-end ileocolic anastomosis was done. Histopathological findings revealed that caecal muscularis propria, and subserosa contain multiple well-formed granulomata composed of epithelioid histiocytes, Langhan's, and foreign body-type multinucleated giant cells and, some of the granulomata contain cell necrosis, definitive caseative-type necrosis not seen, most keeping with tuberculosis, however, features of co-existent Crohn’s disease a possibility. Patient recovered with the therapeutic trail of anti-tuberculous treatment started after histopathology report. Conclusion: One of the rare causes of intestinal perforation is intestinal tuberculosis, the initial surgical management is resection of affected segments with or without primary anastomosis depending on the patient’s clinical condition followed by anti-tuberculous treatment. A therapeutic trial of Anti-tubercular therapy may be useful in differentiating tuberculosis and Crohn’s disease in equivocal cases.