Grieco Michele, Polti Giorgia, Lambiase Lara, Cassini Diletta
General Surgery Department, S Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144 Rome, Rome, Italy.
Immunoinfectivology Department, Bambino Gesù Pediatric Hospital, Piazza di Sant'Onofrio 4, 00165 Rome, Rome, Italy.
Pan Afr Med J. 2019 May 23;33:51. doi: 10.11604/pamj.2019.33.51.14664. eCollection 2019.
Typhoid fever and tuberculosis, considered rare diseases in western countries, is still considered a notable problem of health issue in developing countries. The gastrointestinal manifestations of typhoid fever are the most common and the typhoid intestinal perforation (TIP) is considered the most dangerous complication. Abdominal localization of tuberculosis is the 6 most frequent site for extra pulmonary involvement, it can involve any part of the digestive system, including peritoneum, causing miliary peritoneal tuberculosis (MPT). This is the case report of a 4 years old girl with multiple jejunal perforations in a setting of contemporary miliary peritoneal tuberculosis and typhoid fever occurred in "Hopital Saint Jean de Dieu" in Tanguietà, north of Benin. The patient was admitted in the emergency department with an acute abdomen and suspect of intestinal perforation, in very bad clinical conditions, underwent emergency laparotomy. The finding was a multiple perforations of the jejunum in a setting of combined abdominal typhoid fever and miliary peritoneal tuberculosis. Typhoid intestinal perforations and peritoneal tuberculosis are a very rare cause of non-traumatic peritonitis in western country, but still common in developing country. Considering the modern migratory flux and the diffusion of volunteer missions all around the world, the western surgeon should know this pathological entities, and the best treatments available, well known by surgeons with experience of working in developing countries. The combination of both TIP and MPT in the same patient, is a very rare finding which can worsen the outcome of the patient itself.
伤寒热和肺结核在西方国家被视为罕见疾病，但在发展中国家仍被认为是一个显著的健康问题。伤寒热的胃肠道表现最为常见，而伤寒肠穿孔（TIP）被认为是最危险的并发症。腹部结核是肺外受累的第6个最常见部位，它可累及消化系统的任何部位，包括腹膜，导致粟粒性腹膜结核（MPT）。本文报告了一名4岁女孩的病例，她在贝宁北部坦吉埃塔的“圣若翰医院”同时发生了粟粒性腹膜结核和伤寒热，并伴有多处空肠穿孔。患者因急腹症和肠穿孔疑似被紧急送往急诊科，临床状况极差，接受了急诊剖腹手术。检查发现空肠多处穿孔，同时伴有腹部伤寒热和粟粒性腹膜结核。在西方国家，伤寒肠穿孔和腹膜结核是导致非创伤性腹膜炎的非常罕见的原因，但在发展中国家仍然很常见。考虑到现代移民潮和世界各地志愿者任务的传播，西方外科医生应该了解这些病理实体以及现有的最佳治疗方法，这些方法为有在发展中国家工作经验的外科医生所熟知。同一患者同时出现TIP和MPT是非常罕见的情况，这可能会使患者的病情恶化。
