# An unusual aspect of Pott’s disease: small bowel obstruction from a tuberculous psoas abscess

## TL;DR

A rare case of spinal tuberculosis presented as intestinal blockage, highlighting the importance of considering TB in abdominal emergencies.

## Contribution

Reports a rare clinical presentation of Pott’s disease as small bowel obstruction, emphasizing diagnostic challenges and management.

## Key findings

- Spinal tuberculosis can present as acute small bowel obstruction due to psoas and paravertebral abscesses.
- Computed tomography confirmed ileal wall thickening adjacent to abscesses containing Mycobacterium tuberculosis.
- Conservative management with drainage and anti-tuberculous therapy led to successful outcomes.

## Abstract

Pott's disease typically presents with back pain and systemic symptoms, but atypical presentations can obscure diagnosis. We describe a rare manifestation where the initial presentation was acute small bowel obstruction. A 20-year-old female presented with acute abdominal pain, distension, and vomiting, with a 3-month history of intermittent lower back pain. Computed tomography scan revealed distal ileal obstruction due to wall thickening adjacent to a left psoas abscess and a large paravertebral abscess. Aspirated pus confirmed Mycobacterium tuberculosis. The diagnosis was small bowel obstruction secondary to ileal thickening from an adjacent psoas and paravertebral abscesses. She was managed conservatively with abscess drainage and anti-tuberculous therapy. Intestinal obstruction is a rare presentation of spinal tuberculosis. In endemic areas, tuberculosis should be considered in the differential diagnosis of acute abdomen. Prompt imaging and microbiological confirmation, coupled with multidisciplinary management, are essential to achieve favorable outcomes.