Fig. 4

A 50-year-old man presented with abdominal pain of 1 year duration and weight loss. Abdominal examination revealed an abdominal mass in the left lower quadrant. The patient had anemia (hemoglobin of 87 gm/L) and hypoalbuminemia (28 g/L). Abdominal ultrasound (a) showed matted bowel loops, thickened mesentery, and presence of intraperitoneal fluid. CT abdomen showed thickened intestine with localized ascites and retroperitoneal small lymph nodes. Diagnostic laparoscopy was tried to harvest a biopsy (b). It was difficult and a perforation of the small bowel was suspected. Laparotomy was performed which showed that the small bowel was matted. Intraoperative frozen section confirmed the diagnosis of abdominal tuberculosis. Two iatrogenic small bowel perforations were closed using absorbable sutures. The patient developed postoperative small bowel fistula (yellow arrow)