A Case of Intestinal Tuberculosis Perforation Developing in an Elderly Person with Parkinson Disease

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 44; no. 10; pp. 1287 - 1292
• Main Authors: Tsukuda, Kazunori, Asano, Hiroaki, Naito, Minoru, Muraoka, Takayuki, Harada, Masaaki
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2011
• Subjects: acute abdomen; intestinal perforation; intestinal tuberculosis
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.44.1287

Tuberculosis (TB) morbidity has recently decreased in Japan, but in some categories it has increased, such the elderly and those vulnerable to opportunistic infections. The symptoms of intestinal tuberculosis (TB) are caused mainly by stenosis but rarely by perforation. We encountered a case of intestinal TB perforation developing in a 75-year-old woman who had been treated for Parkinson disease. During hospitalization for appetite loss gastro-intestinal perforation occurred. On emergency laparotomy we found 8 ulcers in the terminal ileum, and 2 of them had caused perforations. We resected 60 cm of the ileum, including the ulcerated sections and made an ileal stoma with an oral side ileum, designating the anal side ileum as the blind edge. Pathological findings of the ileum showed Langhans large cells and acid-fast staining positive bacterial bodies. A cavity lesion with a thick wall was seen in the left lung. The sputum culture revealed a Gaffky score of 5 number and polymerase chain reaction for TB was positive. We diagnosed intestinal perforation with secondary intestinal TB, and we referred her to an indstitution spializing in TB. Administration of 3 kinds of anti-TB drugs converted her TB culture to negative and she went to another rehabilitation facility 9 months after surgery.