Appendicular tuberculosis presenting as enterocutaneous fistula over thigh—A rare case report with review of literature

Abstract

Abdominal tuberculosis is a significant cause of morbidity and mortality in children in developing countries. Primary involvement of appendix is very rare. Presentation is usually non specific and diagnosis is made in most cases on histopathlogical examination following appendicectomy. This to our knowledge is the first case of appendicular tuberculosis presenting primarily as spontaneous enterocutaneous fistula over front of right thigh. Barium meal follow-through was diagnostic. Appendicectomy was performed followed by anti-tubercular treatment which was curative.

Tubercular Appendicitis: A Rare Cause of Acute Abdomen in Children

“…The disease can have presentation: (i) As acute appendicitis as in the present case, (ii) a chronic disease with recurrent episodes of right iliac fossa pain, vomitings, and diarrhea (abdominal TB), (iii) a latent one when discovered incidentally and the appendix is normal in gross appearance, (iv) can present as enterocutaneous fistula. [1,8] The acute presentation can occur due to severe pyogenic infection that is superimposed on the tubercular appendix. Since there are no pathognomic clinical features of appendicular TB, a preoperative diagnosis is difficult to make.…”