Introduction: Abdominal tuberculosis (TB) comprises approximately 5% of all cases of TB and appendix is a relatively rare site for tuberculosis. In this report we present a case of tubercular appendicitis. Case report: A 40 year old female presented to the casualty ward of our hospital with complaints of pain in abdomen and back since two months. There were 2 to 3 episodes of vomiting and the vomitus was bilious in nature. Abdominal examination revealed a soft abdomen with tenderness in right iliac fossa and rebound tenderness with positive Pointing sign and Rovsing sign. Routine haematological investigations of the patient revealed rised counts with negative viral markers. Ultrasonography of the abdomen revealed a peristaltic, tubular non-compressible structure of 8 mm in diameter in right iliac fossa with severe probe tenderness. We decided to perform appendectomy on the patient using a gridiron incision. Biopsy sample showed obliterated lumen with dense and diffuse infiltration by lymphocytes and many granulomas composed of epithelioid cells, langhans giant cells and lymphocytes. Some of the granulomas showed central areas of caseating necrosis. Based on the findings of the biopsy specimen, the patient was diagnosed with granulomatous appendicitis, suggestive of tuberculosis. Anti-tubercular therapy was started postoperatively. The patient recovered completely after completion of the treatment. Conclusion: Preoperative diagnosis of appendicular TB is difficult because of the non-specific symptoms. In most cases, patients present as appendicitis and postoperative biopsy study confirms the diagnosis.
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