Abdominal tuberculosis presenting as a massive lower GI bleed in a cerebral palsy patient - a case report

Q: Why is abdominal tuberculosis difficult to diagnose in some patients?

It often presents with nonspecific complaints and symptom reporting may be limited, making it hard to distinguish from other conditions such as inflammatory bowel disease.

Q: What diagnostic and initial treatment steps were attempted in this case?

Angioembolization was used for a bleeding cecal mass identified on computed tomography, and an infectious workup and imaging were performed before definitive surgery.

Q: How was the final diagnosis confirmed?

Emergent exploratory laparotomy with resection of a bleeding ileocecal mass was performed, and abdominal tuberculosis was confirmed on pathology.

Sep 29, 2026

Upload by CatatanPagi

Abdominal tuberculosis is a rare extrapulmonary form of TB increasingly seen in hospitals serving growing immigrant populations. Diagnostic differentials frequently overlap with inflammatory bowel disease, and diagnostic laparoscopy can remain highly effective, especially when patients cannot reliably report symptoms. The report describes a 52-year-old woman with cerebral palsy whose pulmonary symptoms progressed to massive lower gastrointestinal bleeding. After initial improvement with angioembolization failed, emergent exploratory laparotomy identified an ileocecal bleeding mass confirmed as abdominal tuberculosis on pathology.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract

Introduction

Case presentation

Journal of Surgical Case Reports, 2026, 1, rjaf1029 [https://doi.org/10.1093/jscr/rjaf1029](https://doi.org/10.1093/jscr/rjaf1029) Case Report Case Report Abdominal tuberculosis presenting as a massive lower GI bleed in a cerebral palsy patient—a case report Alexander M. Kravets 1 , 2 , *, Dzhastyn Dkhillon1 , 2 , Zachary Gross1 , 2 , Sholom-Ber Chernyak1 , 2 , Eugene Tarasov2 1 Department of Surgery, Franciscan Health Olympia Fields, 20201 South Crawford Ave, Olympia Fields, IL, United States 2 Resurrection Medical Center, 7435 W Talcott Ave, Chicago, IL, United States *Corresponding author. Department of Surgery, Franciscan Health Olympia Fields, Olympia Fields, IL, United States. E-mail: [alexandermkravets@gmail.com](alexandermkravets@gmail.com) Abstract Abdominal tuberculosis is a rare extrapulmonary manifestation of tuberculosis (TB), one that is increasingly encountered at hospitals serving a growing immigrant population. Since the COVID-19 pandemic, the incidence of TB has continually increased. The diagnostic differential often overlaps with inflammatory bowel disease, with diagnostic laparoscopy remaining the most effective modality of diagnosis. Additional diagnostic difficulties are encountered in patients unable to report symptoms. We present the case of a 52-yearold woman with cerebral palsy who presented initially with pulmonary symptoms and later developed massive lower gastrointestinal bleeding. Conservative management was attempted with angioembolization of a bleeding cecal mass on computed tomography. The patient initially improved and then decompensated after several hours. The patient then underwent emergent exploratory laparotomy for resection of a bleeding ileocecal mass which was found to be abdominal tuberculosis on pathology. Keywords: abdominal tuberculosis; tuberculosis; lower GI bleed; cerebral palsy Introduction Public health measures and effective chemotherapy have largely improved overall outcomes in patients with tuberculosis (TB) . Although the incidence of tuberculosis decreased in the United States over the course of the 20th century, a resurgence has occurred due to the advent of the human immunodeficiency virus (HIV) and an increase in immigration [1] . Moreover, there has been a spike in TB cases since the COVID-19 pandemic. Tuberculosis remains largely manageable with antituberculosis chemotherapy; however, extrapulmonary manifestations of tuberculosis continue to contribute to significant morbidity and mortality. Extrapulmonary manifestations of tuberculosis are often difficult to diagnose and manage. In cases of abdominal tuberculosis, patients present with nonspecific complaints, such as abdominal pain, systemic symptoms, and—occasionally—gastrointestinal (GI)-related complications. Abdominal tuberculosis is often diagnosed intraoperatively and patients are effectively managed with anti-TB chemotherapy [1–3] . Case presentation A 52-year-old woman was brought by her family from home to the emergency room for fever, shortness of breath, and congestion over the last 2–3 days. Her sister normally provides care and denied any medical history or prior hospitalization in the past 25 years. The family was noted to have immigrated from the Indian subcontinent. The patient was noted to be cachectic, weighing only 67 pounds. Her sister claimed the patient was normally ambulatory and feeding herself with assistance. The patient was nonverbal at baseline. The vitals included a maximum temperature of 101.8◦ C, tachycardia which responded to fluid boluses, hypotension, intermittent desaturation to the low 80s, coarse lung sounds, and benign abdominal exam . Labs included elevated sodium at 155, potassium at 2. 8, bicarb at 20, albumin < 1.5 g/dl, lactate at 3. 3, a WBC count of 9.1 cells/mm3 , and hemoglobin at 10.9 g/dl. Chest X-ray demonstrated coarse interstitial markings. The patient was then started on ceftriaxone and azithromycin for possible secondary pne

FAQs

Why is abdominal tuberculosis difficult to diagnose in some patients?

It often presents with nonspecific complaints and symptom reporting may be limited, making it hard to distinguish from other conditions such as inflammatory bowel disease.

What diagnostic and initial treatment steps were attempted in this case?

Angioembolization was used for a bleeding cecal mass identified on computed tomography, and an infectious workup and imaging were performed before definitive surgery.

How was the final diagnosis confirmed?

Emergent exploratory laparotomy with resection of a bleeding ileocecal mass was performed, and abdominal tuberculosis was confirmed on pathology.

Sep 29, 2026

Upload by CatatanPagi