Isolated ileal tuberculosis presenting as massive lower gastrointestinal bleeding: rare case report

Intestinal tuberculosis (TB) is a common form of extrapulmonary (EPTB) in developing countries. It usually presents with obstruction, perforation, or malabsorption. Presentation as massive lower gastrointestinal (LGI) bleeding is extremely rare. A 65-year-old male, presented with sudden onset of massive bleeding per rectum associated with haemorrhagic shock. He required multiple Blood products transfusion. Contrast-enhanced CT abdomen showed distal ileal wall thickening with intraluminal contrast extravasation, suggestive of a vascular malformation. Laparotomy showed multiple areas of congestion and ulceration noted in distal ileum with active bleed intraluminally, associated enlarged mesenteric lymph nodes present. Limited ileocecal resection was performed. Histopathological examination revealed granulomatous lesion-Koch’s etiology. Isolated lleal TB, rarely presents as massive lower GI bleeding. Early surgical intervention plays a vital role in both diagnosis and management, especially when the patient presents with hemodynamic instability