Intestinal Tuberculosis with Enterocutaneus Fistula: A Rare Case

Introduction: Enterocutaneous fistula is a common postoperative complication. The incidence of enterocutaneous fistula as a complication of intestinal tuberculosis is quite rare, so we are interested in reporting this case.

Case Report: 32-year-old male presented with history of abdominal pain and fecal matter coming out from an opening in umbilical region for the past 1 month. Patient have history of laparotomy exploration 7 months ago and histopathology showed intestinal tuberculosis. Currently, patient was undergoing TB treatment with anti-tubercular treatment (ATT) for the seventh month. Physical examination showed fistulous opening 2x2 cm over the scar of previous laparotomy. Laboratory examination revealed leukocytosis shift to the left and hypoalbuminemia. Chest X-ray showed active pulmonary tuberculosis. Abdominal CT with with contrast showed localized ileus consist of sentinel loop and suggestive intestinal tuberculosis. Diagnosis of tubercular enterocutaneus fistula arising of as a post-operative complication was made. Patient was given intravenous fluids, antibiotics, antitubercular treatment, and wound care. Patient responded well to conservative management.

Discussion: Intestinal tuberculosis (TB) is  the  sixth  most  common  site  of extrapulmonary  tuberculosis which can occur primary or secondary. Enterocutaneus fistula (ECF) is a rare complication of intestinal TB and can be managed based on whether the output is low or high. Conservative management can be done through administration of intravenous fluids, antibiotics, antitubercular treatment, and wound care