Young woman recovers after two major surgeries and intensive management for multiple small bowel perforations caused by abdominal tuberculosis
Nagpur, 8th May 2025: A 24-year-old female patient presented to the OPD at Wockhardt Hospitals, Nagpur with recurrent abdominal pain, fever, nausea, vomiting, and significant weight loss. Upon admission, she underwent a thorough clinical evaluation. A Contrast-Enhanced CT (CECT) scan of her abdomen revealed pneumoperitoneum — a serious indication of hollow viscus perforation, either in the small or large bowel.
With this alarming finding, the patient was carefully optimized and prepared for surgery. An exploratory laparotomy was performed by Dr Ankur Mishra,General and Laparoscopic Surgeon at Wockhardt Hospitals, Nagpur. Intraoperatively, surgeons found dense interbowel adhesions and numerous small tubercles studded across the small intestine, stomach, and liver — signs strongly suggestive of abdominal tuberculosis.
Further exploration revealed 6–8 perforations in the proximal jejunum and 4–5 in the distal ileum. A decision was made to perform extensive resection and anastomosis at two bowel segments. The affected sections of the small intestine were resected, and continuity restored with anastomoses.
Postoperatively, she was managed in the ICU under the care of Dr. Chetan Sharma and Dr. Rahul Hiwanj at Wockhardt Hospitals, Nagpur. She gradually improved and was weaned off ventilator support. Her histopathology and microbiology confirmed the diagnosis of intestinal tuberculosis (Koch’s abdomen), and she was initiated on anti-tubercular therapy (ATT) alongside supportive antibiotics.
As she began to recover and tolerate oral fluids, she developed a bile leak from the left-sided abdominal drain on post-operative day six. A CT scan with oral contrast revealed a leak at the proximal jejunal anastomosis site. She underwent a second exploratory surgery the same day. This time, three new perforations near the duodenojejunal flexure and two in the distal ileum were found. Surgeons performed another resection-anastomosis, primary closure of the jejunal perforations, and inserted a feeding jejunostomy for enteral nutrition.
Despite this, bile leakage persisted post-surgery. The patient was managed conservatively using Total Parenteral Nutrition (TPN), enteral feeds via jejunostomy, ATT, and antibiotics. Over the next 2–3 weeks, the biliary drain output decreased dramatically from 900 mL/day to just 10 mL/day. She gradually resumed oral liquid intake, tolerated it well, and passed stools normally. She was then shifted to the ward and continued on a liquid diet.
After a prolonged 4-week recovery period, biliary drainage completely ceased, and the patient remained hemodynamically stable with no signs of infection or fever. She was discharged after five weeks on a soft and liquid diet, with both surgical drains removed. A follow-up after 15 days confirmed her continued recovery with no complaints of pain, vomiting, or fever.
Medical Insight: Intestinal Tuberculosis – A Hidden Threat
Intestinal tuberculosis remains a significant health burden, especially in developing countries. Its symptoms — including abdominal pain, night sweats, and weight loss — are often nonspecific, making diagnosis challenging. The disease is associated with high mortality rates when presenting as small bowel perforations, with some studies quoting up to 90%.
This case highlights the critical role of early surgical intervention and coordinated post-operative care. The team at Wockhardt Hospitals, Nagpur employed a combination of surgical precision, intensive care, and targeted anti-tubercular therapy, resulting in a complete recovery of a patient with a life-threatening condition.
The successful management of this rare and complicated case once again reflects the clinical excellence and advanced capabilities of Wockhardt Hospitals, Nagpur in handling complex abdominal and infectious diseases.
