Abdomen agudo ocasionado por apendicitis aguda de probable origen tuberculoso. Informe de un caso / Acute abdomen probably caused by acute tuberculous appendicitis. A case report / Abdome agudo ocasionado por apendicite aguda tuberculosa. Informe de um caso

RESUMEN Antecedentes: la apendicitis aguda tuberculosa es una enfermedad rara, constituye de 0,001 % a 0,01 % de las formas clínicas de tuberculosis. Se presenta un caso de apendicitis aguda probablemente tuberculosa como causa de abdomen agudo quirúrgico. Caso clínico: hombre de 29 años con cuadro de dolor abdominal leve a moderado que se intensificó y localizó en el hemiabdomen derecho, claudicación, febrícula, vómito, mal estado general, leucocitosis de 11 300/µL y neutrofilia de 91 %. Se hizo apendicectomía, el reporte histopatológico fue de apendicitis aguda y la tinción de Ziehl Neelsen fue positiva. A los tres días regresó a su domicilio y no presentó complicaciones a corto ni a largo plazo. Conclusión: la apendicitis aguda tuberculosa es una entidad rara que puede ocasionar abdomen agudo; los pacientes deben recibir tratamiento medicamentoso para erradicar la causa y tener un seguimiento epidemiológico adecuado.

SUMMARY Background: Acute tuberculous appendicitis is a rare disease. It constitutes from 0.001 % to 0.01 % of the clinical forms of tuberculosis. We present cases of such disease as probably cause for surgical acute abdomen. Case report: Male aged 29 with mild to moderate diffuse abdominal pain, which intensified and localized in the right lower quadrant of the abdomen, fever, vomiting, malaise, leukocytosis (11,300/µL) and 91 % neutrophils. Appendectomy was performed, the histopathological report was acute appendicitis, Ziehl-Neelsen stain was positive. Three days later he returned home and had no short- or long term complications. Conclusion: Acute tuberculous appendicitis is a rare disease that may cause acute abdomen, patients should receive drug treatment to eradicate the cause and have proper epidemiological monitoring.

RESUMO Antecedentes: a apendicite aguda tuberculosa é uma doença rara, constitui de 0,001 % a 0,01 % das formas clínicas de tuberculose. Se apresenta um caso de apendicite aguda tuberculosa como causa de abdome agudo cirúrgico. Caso clínico: homem de 29 anos com quadro de dor abdominal leve a moderado que se intensificou e localizou no hemiabdome direito, claudicação, febrícula, vómito, mal estado em geral, leucocitose de 11 300/µL e neutrofilia de 91 %. Se fez apendicectomia, o relatório histopatológico foi de apendicite aguda e a técnica de Ziehl Neelsen foi positiva. Aos três dias regressou a seu domicílio e não apresentou complicações a curto nem a longo prazo. Conclusão: a apendicite aguda tuberculosa é uma entidade rara que pode ocasionar abdome agudo; os pacientes devem receber tratamento medicamentoso para erradicar a causa e ter um seguimento epidemiológico adequado.

[Chronic appendicitis due to multiple fecaliths. A case report]. / Apendicitis crónica ocasionada por fecalitos múltiples. Reporte de un caso.

BACKGROUND: The appendix inflammatory process is the most common cause of chronic abdominal pain in the right lower quadrant. The frequency of appendiceal lumen obstruction by fecalith ranges from 10 to 20%; few cases of obstruction by multiple fecaliths had been reported. CLINICAL CASE: Sixty-nine years old male, diabetic and hypertensive in control, he underwent bowel resection 30 years previously. He completed 6 months with intermittent, mild pain in the right lower quadrant abdomen; 14 days prior to admission with increasing pain, nausea, vomiting, constipation, abdominal distension and absence of peristalsis; 12,750 leukocytes, neutrophils 90%; plain abdominal radiography without specific bowel pattern, TAC with 3 dense images in right lower quadrant; exploratory laparotomy was performed and perforated appendix with 3 free fecaliths was found. Histopathological report showed fibrosis and lymphocytic infiltrate in the muscle layer of the cecal appendix consistent with chronic appendicitis. CONCLUSIONS: The most common obstruction of the appendix lumen is by a single fecalith. In this case the patient had chronic appendicitis secondary to appendiceal lumen obstruction by multiple fecaliths. Reviewing the international literature any case of chronic appendicitis associated with the presence of multiple fecaliths was found.