Peritoneal and nodal abdominal tuberculosis presenting as intestinal obstruction mimicking malignancy: a case report

Abdominal tuberculosis (TB) is an uncommon form of extra pulmonary TB that often presents with nonspecific symptoms and poses significant diagnostic challenges. Its clinical and radiologic features can closely mimic malignancy and other abdominal pathologies, frequently leading to delayed diagnosis and management, especially in resource-limited settings. We report a 20-year-old Eritrean male presenting with a 1-month history of abdominal pain, fever, weight loss, and later respiratory symptoms. Initial evaluation suggested pneumonia; however, persistent symptoms and development of small bowel obstruction prompted surgical exploration. Intraoperative findings revealed multiple peritoneal tubercles and enlarged mesenteric lymph nodes causing extrinsic bowel compression without adhesions or strictures. Histopathology confirmed abdominal TB despite negative sputum AFB, GeneXpert, and tuberculin skin test. The patient completed 6 months of anti-tuberculous therapy with full recovery and no recurrence at 3-year follow-up. This case highlights the rare presentation of abdominal TB causing bowel obstruction without adhesions, strictures, or mass lesions, mimicking intestinal malignancy. It underscores the importance of maintaining high clinical suspicion for abdominal TB in endemic regions, the limitations of conventional diagnostics in malnourished patients, and the crucial role of surgical biopsy for definitive diagnosis.