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.