IDDF2019-ABS-0040 A rare case of ileo-colic tuberculoma presenting as intussusception in an adult. a case presentation

<h3>Background</h3> Abdominal tuberculosis is regarded as a great mimicker of other abdominal pathology and is an increasingly common disease that poses a diagnostic challenge. On the other hand, Intussusception in the adult population is a very rare occurrence and a demonstrable etiology is found in 70–90% of cases. We present a very rare event of secondary intussusception wherein tuberculoma is the lead point. <h3>Methods</h3> A case of 42-year-old female who presented with abdominal distention for one week, with decreased in bowel movement. On physical examination of the abdomen, it revealed a distended with tenderness on the left quadrant area. A CT scan was done and revealed a high probability of ileocecal intussusception, and a chest radiograph of Pulmonary Tuberculosis. <h3>Results</h3> Exploratory Laparotomy was immediately scheduled and revealed ascites, bowel thickening, massive mesenteric lymphadenopathy, bowel stricture 60 cm from the ileocecal valve and an ileocolic intussusception with tuberculoma as the lead point. A right hemicolectomy extending to the midportion of the jejunum was done. The postoperative course was uneventful and she was discharged on the 6th post-operative day. Histopathology revealed necrotising granulomatous inflammation highly suggestive of TB. <h3>Conclusions</h3> Abdominal tuberculosis is still a major health problem in many parts of the world. Even in developed countries, incidence has been steadily increasing due to AIDS epidemic, transglobal migration and increased number of immunosuppressed patients. Due to lack of specific symptoms and signs of intestinal tuberculosis, most patients present with complications like intestinal perforation or obstruction or even fistula formation. Still, intussusception as a presentation of intestinal tuberculosis is a very rare event. Inflammatory adhesions around the ileocecal region might be the probable reason for intussusception in our case