Multiple spontaneous jejunal and ileal perforations: a diagnostic challenge

Vijayalakshmi Sunder, Shanthi Ponandal Swaminathan, Vikas Kawarat, Kamalraj Maiyazhagan, Shriram Khanna, Rajeswari Mani, Kannan Ross


Spontaneous multiple jejunal perforations are rare. In India, the commonest cause of small bowel perforation is typhoid fever followed by tuberculosis. We report a case of multiple jejunal and ileal perforations in a 23-year-old young woman who was known to have ulcerative colitis on medical therapy including steroids. She was then diagnosed to have active pulmonary tuberculosis and commenced on anti-tuberculosis therapy. She presented with generalised peritonitis and underwent emergency bowel resection with proximal enterostomy and creation of mucous fistula of the distal ileum. Post-operative course was stormy due to sepsis and she eventually succumbed on the 3rd post-operative day. Histopathological examination revealed non-specific changes and was not contributory to diagnosis. Possible causes of spontaneous jejunal perforations are discussed and the literature is reviewed. This case, despite a fatal outcome, is being reported to highlight the need for high index of suspicion in such situations.


Jejunal perforations, Ileal perforations, Tuberculosis, Typhoid fever, Coeliac disease

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