Abdominal Tuberculosis in an Inguinal Hernia: A Rare Case Report

Abstract: Abdominal tuberculosis is a form of extrapulmonary tuberculosis that can involve various intra-abdominal organs. Tuberculosis involvement in an inguinal hernia is a rare condition that can pose challenges for both diagnosis and management. This case report aims to describe the manifestations of abdominal tuberculosis in a patient with an inguinal hernia. We reported a 54-year-old male presented with complaints of pain in the right groin, starting one day prior to hospital admission. A lump had been present for two years—particularly during physical activity—and would reduce upon resting. The patient had a history of pulmonary tuberculosis and had completed a full course of anti-tuberculosis medication. He subsequently underwent hernioplasty. Intraoperative findings revealed a hernia sac containing small bowel with mesenteric hyperemia and approximately 20 mL of peritoneal fluid. Acid-fast bacilli (AFB) examination of the peritoneal fluid using Ziehl-Neelsen staining yielded a 3+ result. Anti-tuberculosis therapy was initiated on the third postoperative day. Two weeks post-surgery, the surgical wound showed no signs of infection, and there were no complaints regarding the digestive or respiratory systems. The patient attended regular follow-up appointments at the DOTS clinic. In conclusion, abdominal tuberculosis involving an inguinal hernia is a rare condition that should be considered in patients with a history of tuberculosis and unusual intraoperative findings. Microbiological examination of peritoneal fluid and histopathological analysis of the affected tissue can assist in establishing the diagnosis. Management involving surgery intervention combined with anti-tuberculosis therapy can be implemented based on the patient's clinical condition. Keywords: abdominal tuberculosis; inguinal hernia; hernioplasty; acid-fast bacilli