A rare case of primary tuberculous appendicitis in a secondary care hospital in eastern India: a case report

Abstract

Primary tuberculous appendicitis is described as a histological confirmation of appendicular tuberculosis with negative chest X-ray and no evidence of tuberculosis found elsewhere in the body, and constitutes only 0.1-3% of all appendicectomies. A 21-year-old male patient presented to the emergency of our secondary care hospital, complaining of recurrent colicky right lower abdominal pain, nausea, with two months of persistent loss of appetite, increased frequency of micturition, weight loss, malaise, and evening temperature rise. There was tenderness at McBurney’s point with positive obturator test. Ultrasound of abdomen found enlarged appendix, further confirmed by Barium meal follow-through of abdomen. With a provisional diagnosis of recurrent acute appendicitis, the patient was taken for emergency open appendicectomy under spinal anesthesia. Intra-operatively, appendix in pelvic position, was thickened up to the base, approximately 4 cm in length, wholly adhered to the greater omentum, with no perforation, and no peri-appendiceal fluid collection. Microscopic examination showed epithelioid granulomas with Langhans' and foreign body giant cells. Foci of necrosis was present. Correlating with the clinical picture, intra-operative and histopathological findings, patient was definitively diagnosed with primary tuberculous appendicitis. The patient was started on anti-tubercular treatment for extrapulmonary TB and is currently followed up at the TB cell at our hospital. As tuberculosis is targeted for elimination under national tuberculosis elimination program (NTEP), we strongly recommend that all appendicectomy be followed by a histopathological examination to detect this rare tuberculosis.