case_images: PMC10848178_01
case_images: Radiograph of the abdomen in standing view. The erect abdominal X-ray revealed dilated small bowel loops with multiple air-fluid levels, suggestive of small bowel obstruction.
case_images: cureus-0016-00000051836-i01.jpg
case_images: PMC10848178_01_cureus-0016-00000051836-i01.jpg
case_images: FIG1
case_images: An erect abdominal radiograph revealed dilated loops of the small intestine with multiple air-fluid levels suggestive of small intestine obstruction (Figure 1).
case_images: Contrast computed tomography scan of the abdomen, axial views.. Image A: A contrast computed tomography scan axial image showing abdominal lymphadenopathy (yellow arrow) and small bowel stricture (red arrow). Image B: Contrast computed tomography scan axial image showing long segment circumferential bowel wall thickening with luminal narrowing suggesting small bowel stricture (red arrows) and ascites (blue arrowhead).
case_images: cureus-0016-00000051836-i02.jpg
case_images: PMC10848178_01_cureus-0016-00000051836-i02.jpg
case_images: FIG2
case_images: Mesenteric and retroperitoneal lymphadenopathy with central necrosis was observed along with mild to moderate ascites (Figures 2, 3).
case_images: Contrast computed tomography scan, coronal and sagittal views. Image A: Contrast computed tomography scan coronal image showing abdominal lymphadenopathy (yellow arrow), small bowel stricture (red arrows), and ascites (blue arrowheads). Image B: Contrast computed tomography scan sagittal image showing abdominal lymphadenopathy (yellow arrows) and small bowel stricture (red arrow).
case_images: cureus-0016-00000051836-i03.jpg
case_images: PMC10848178_01_cureus-0016-00000051836-i03.jpg
case_images: FIG3
case_images: Mesenteric and retroperitoneal lymphadenopathy with central necrosis was observed along with mild to moderate ascites (Figures 2, 3).
case_images: Gross appearance of resected bowel. Image A: Specimen of resected bowel showing areas of strictures (pointed by forceps). Image B: Subserosal nodules/tubercles (highlighted by black circles). Images C and D: Cut sections of the intestine from the areas of strictures showing the bowel wall thickening.
case_images: cureus-0016-00000051836-i04.jpg
case_images: PMC10848178_01_cureus-0016-00000051836-i04.jpg
case_images: FIG4
case_images: The serosal surface had many tiny nodules/tubercles (Figure 4).
case_images: Histomicrograph of the intestinal strictured areas and lymph node. Image A: Granuloma (black arrows) with multinucleated giant cells (yellow arrow) are present in all layers of the intestine - mucosa, muscularis propria, extending up to serosa (Hematoxylin and Eosin stain, 100x). Image B: Subserosal nodule (black arrow) showing granulomas (Hematoxylin and Eosin stain, 100x). Image C: The lymph node has been replaced by granulomas, characterized by epithelioid cells (black arrowheads) (Hematoxylin and Eosin stain, 400x). Image D: Ziehl-Neelsen stain of subserosal nodule showing acid-fast bacilli (red arrow) (1000x).
case_images: cureus-0016-00000051836-i05.jpg
case_images: PMC10848178_01_cureus-0016-00000051836-i05.jpg
case_images: FIG5
case_images: Fourteen out of the 22 lymph nodes showed granulomatous reaction and ZN staining did not reveal any AFB (Figure 5).