An 18-year-old female patient with no notable pathological history, consulted for chronic pain in the right iliac fossa evolving in a context of anorexia and weight loss of 10 kg in 4 months. On general examination, the patient was apyretic, conscious, and hemodynamically stable, and her conjunctiva was normally colored. The physical examination revealed a subumbilical mass mobile in both superficial and deep planes, undefined borders, and extending into the right iliac fossa; no hepatomegaly, splenomegaly, or lymphadenopathy was detected. Other systemic examinations were unremarkable. Her blood investigations were normal; her chest X-ray was also normal. The abdominal CT scan (Figure 1) showed two contiguous, well-limited, rounded formations with thick fluid content and thin, regular walls, they measured, respectively, 20 mm at the level of the right iliac fossa and 72 mm at the abdominopelvic level, under the umbilicus. The pelvic magnetic resonance imaging (Figure 2) showed a median intraperitoneal pelvic mass hyposignal on T1 and hypersignal on T2 and regular parietal enhancement after injection with mural nodules, it measured 77 x 81 x 80 mm; this mass was supravesical, coming into contact with the ileal intestines, the sigmoid, and the uterus behind it, keeping a separation line.
Laparotomy exploration showed a mesenteric mass close to the ileocaecal region, solid hyper vascularized with some ileocaecal lymph nodes (Figure 3); the appendix and the ovaries appeared normal; a monobloc resection of the mass with the satellite lymph nodes was performed without intestinal resection (Figure 4). The postoperative course was simple, and she was discharged home after 4 days in good general condition.
Microscopic pathologic examination was in favor of a necrotizing granulomatous lymphadenitis which was highly indicative of tuberculosis (Figures 5 and 6). Polymerase chain reaction (PCR) test of the specimen was positive for Mycobacterium tuberculosis.
Quadruple therapy for tuberculosis with isoniazid, rifampicin, pyrazinamide, and ethambutol was prescribed for a two-month initial phase of treatment followed by a four-month continuation phase of isoniazid and rifampicin. In patient's follow-up, general condition was good and no problem was reported.