Perforated Gastric Tuberculosis: A Rare Complication of a Rare Disease

Abstract

A 30-year old physician presented with acute abdominal findings compatible with acute appendicitis. Chest roentgenogram was normal. After appendectomy, the patient slowly improved. Microscopically the appendix displayed only peri-appendicitis, prompting upper gastrointestinal and computerized tomographic examinations. The latter revealed a lesser sac abscess which was drained. Despite drainage, the abscess recurred and the patient was reexplored. A minute perforation of the distal stomach, communicating with the lesser space, was closed and the area widely drained. The patient developed a low-output gastrocutaneous fistula which failed to close with conservative treatment. The patient remained well clinically, even with fistulous involvement of the right colon. Endoscopic biopsy revealed granulomatous gastritis without acid-fast bacilli. Several months later a large inguinal lymph node was excised and found to have caseating granulomas with acid-fast bacilli. All fistulous drainage resolved after initiating antituberculous therapy and the patient has remained well. This case appears to be the first report of gastric tuberculosis causing an acute abdomen due to perforation. This rare curable condition should be considered when evaluating gastric pathology.