Perforated pan-enteric tuberculosis: intra operative recognition necessity!

A 24-years-old man presented to the emergency department with complaints of progressively worsening abdominal pain, occurring on the background of fever. On examination, his abdomen was diffusely tender with board-like rigidity. His hematologic investigations revealed high blood cells count. After initial assessment a diagnosis of generalized peritonitis was made. He underwent emergency laparo- scopy, with intra operative findings of general peritonitis. The small bowl was dilated and the caecum was not in his usual localization. The conversion from laparoscopic to open surgery was decided. The small bowl wall was thick and tubular with no stricture (Fig. 1). There were two perforations situated on 1m50 and 1m80 from duodeno-jejunal junction. There were stony lymph nodes without sclerolipomatosis. The unusual location of the caecum was due to common mesentery (Fig. 1). We realized a peritoneal lavage and a resection of 40 cm of the small bowl. The two ends were brought out as double-barreled ostomy. An appendicectomy was also performed. A chest x-Ray (Fig. 2) was realized after surgery and showed pulmonary cavity and pulmonary interstitial syndrome.