CASE HISTORY

The patient, a man aged 34, underwent laparotomy for a perforated appendix, 5 months later he developed acute intestinal obstruction which resolved after an enema. 3 months later he had a similar attack, and a barium meal failed to reveal an obstruction. Following a 3rd attack some weeks later laparotomy was performed and coils of adherent inflamed gut were found in the right iliac fossa. Part of the ileum, the caecum and proximal ascending colon were resected and ileo-colic anastomosis performed. The lesion was diagnosed as tuberculosis and for 5 years he was well. But after a series of attacks of abdominal pain and vomiting over a period of 7 years, 105cm of small bowel were resected.

PATHOLOGY

The specimen shows part of the bowel bearing several strictures with an ulcerated surface. A crop of minute tubercles are seen over the serosal aspect of one of these.