Case History
A 36-year-old woman with a history of abdominal tuberculosis had
received two months of treatment with anti-tuberculosis drug. She had
also undergone an incision and drainage procedure for a psoas abscess.
The patient now presented to the emergency department experiencing
leakage of fecal matter from her right flank region. She described that
for the previous two weeks, she had been experiencing a foul-smelling,
feculent discharge from her right lower abdomen. Fever, nausea, and
reduced appetite were present along with the other symptoms.In the
preceding six months, she had struggled with intermittent constipation
and had experienced occasional per rectal bleeding. Moreover, she
mentioned significant weight loss over the last three months.
Importantly, she confirmed that there was no family history of
tuberculosis, colon cancer, or any malignancies.
Upon physical examination, she appeared to be in a weakened state,
confined to her bed, and showed signs of malnourishment. Vital signs
taken upon admission indicated that she was running a fever and
exhibited tachycardia. Closer inspection revealed spontaneous feculent
drainage through an anterolateral opening on her anterior abdominal wall
shown in Figure 1 . This area showed signs of edema. In
the right iliac fossa, a firm to hard mass measuring approximately 10x10
cm was identified. Aside from this, her abdomen felt soft without any
tenderness. A rectal examination revealed a normal tone, but the
examining finger was stained with feces, although no palpable mass was
identified internally.