Tuberculous peritonitis after conservative treatment for acute perforated appendicitis: a case report

TL;DR

A patient developed tuberculous peritonitis after conservative treatment for appendicitis, highlighting a rare but possible complication.

Contribution

This case report is the first to document tuberculous peritonitis following conservative treatment for perforated appendicitis.

Findings

A 67-year-old immunocompromised patient developed tuberculous peritonitis three months after conservative appendicitis treatment.

Tuberculous peritonitis was confirmed via intraoperative findings, pathology, and T-SPOT.TB test.

The patient recovered after antituberculosis treatment, suggesting the condition is treatable.

Abstract

Interval appendectomy is widely recommended for patients with abscesses due to perforated appendicitis. A concomitant malignancy-related problem was reported after conservative treatment of acute appendicitis with abscess, but perforated appendicitis-associated tuberculous peritonitis was never reported.

A 67-year-old male patient with a laryngeal cancer history presented to our hospital with an acute appendicitis-associated ileal abscess. He was scheduled for an interval appendectomy after conservative treatment. Fortunately, the symptoms subsided, and the patient was discharged for a later scheduled appendectomy. However, after 3 months, he was readmitted to our hospital with fever and abdominal pain, and emergency surgery was performed, which was suspected to be peritonitis. Intraoperative results revealed numerous white nodules in the abdominal cavity. The condition was diagnosed as tuberculous peritonitis based on macroscopic results, later pathological findings, and positive T-SPOT.TB. The antituberculosis medications were effective, and the patient recovered and was discharged from the hospital 8 days thereafter.

Patients, particularly those immunocompromised, may develop tuberculous peritonitis after conservative treatment for acute perforated appendicitis.

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