title: Retroperitoneal perforation of the colon caused by colonic tuberculosis: report of a case.
abstract: We present a 25-year-old, HIV-negative patient from Kosovo, with no significant past medical history, who was admitted to a local hospital for nonspecific upper abdominal discomfort. He was transferred to us after a retroperitoneal mass with contact to the right colonic flexure had been found during workup. Colonoscopy demonstrated an edemateous area with a central fistula in the right flexure, and histology showed caseous necrosis. Although neither bacteriology nor histology could detect any germs, gastrointestinal tuberculosis seemed to be very probable. Laparotomy with a segmental resection of the colon was performed to remove the fistula-bearing segment, and histologic examination of the resected specimen confirmed the intraoperative suspect of a retroperitoneal colonic perforation. Again, all cultures from the specimen were negative for tuberculosis, but polymerase chain reaction of a regional lymph node revealed acid-fast bacilli of the Mycobacterium tuberculosis/bovis species. Although the patient had no other sites of tuberculosis infection like pulmonary or urinary, he received adjuvant standard tuberculosis treatment for six months. At control examination one year after the operation, the patient was free of recurrence and in very good general condition. We report this extremely rare presentation of gastrointestinal tuberculosis to sensitize physicians to tuberculosis again, because incidence rates are increasing and this disease will certainly play a more important role in the future.
authors.affiliation: Department of Visceral and Transplantation Surgery, Zürich, Switzerland. stefan.heinrich@chi.usz.ch
authors.forename: Stefan
authors.initials: S
authors.lastname: Heinrich
authors.forename: Franc Heinrich
authors.initials: FH
authors.lastname: Hetzer
authors.forename: Peter
authors.initials: P
authors.lastname: Bauerfeind
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jochum
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D003082:Colectomy; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003113:Colonoscopy; D003131:Combined Modality Therapy; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D007416:Intestinal Perforation / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D008297:Male; D009163:Mycobacterium bovis / Q000235:genetics; D009336:Necrosis; D016133:Polymerase Chain Reaction; D035583:Rare Diseases; D012187:Retroperitoneal Space; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014385:Tuberculosis, Gastrointestinal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis / Q000628:therapy; D015022:Yugoslavia
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial