Introduction: Tuberculosis is known as a notorious mimicker and distinguishing between intestinal tuberculosis and Crohn's disease is a huge diagnostic challenge.
Case description: Here, we report a case of hollow organ perforation due to intestinal tuberculosis that was previously mistreated as Crohn's disease. Staged operation with emergency resection of the diseased small bowel and temporary ileostomy was performed for the perforation, followed by 6-month standard treatment for miliary tuberculosis, which was diagnosed on the basis of the presence of acid-fast bacilli in the diseased bowel and positive culture of Mycobacterium tuberculosis from sputum, ascites, and stool samples. Ileostomy takedown was performed, and the continuity of the gastrointestinal tract was restored 6 months after the first surgery. The patient recovered well thereafter.
Conclusion: Timely surgical intervention can help establish the finial diagnosis of tuberculosis, rescue the patient from abdominal emergency, and provide a chance for cure.
Keywords: Bowel perforation; Crohn’s disease; Intestinal tuberculosis.