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LETTER TO THE EDITOR
Christopher CK Ho
Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Submitted December 6, 2010 - Accepted for Publication December 20, 2010
KEYWORDS: Spontaneous bladder perforation; Tuberculosis; Management.
CORRESPONDENCE: Dr. Christopher C.K. Ho, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia ().
CITATION: Urotoday Int J. 2011 Feb;4(1):art12. doi:10.3834/uij.1944-5784.2011.02.12
I read with interest the manuscript by Sallami et al  on the spontaneous intraperitoneal perforation of the bladder secondary to tuberculosis. It is indeed sad to note that the patient died a day after surgery without reinstituting anti-tuberculosis treatment.
What puzzles me is that the clues to the diagnosis were already there (ie, the previous history of pulmonary tuberculosis, chest x-ray showing miliary tuberculosis and the fact that tuberculosis is prevalent in Tunisia). The authors even alluded that the intraoperative findings were suggestive of chronic infection and they had suspected tuberculosis. Anti-tuberculosis treatment should have been instituted empirically and this has been shown to be effective in 2 previous cases reported where the patients survived [2,3].
This case report highlights the need for surgeons to be vigilant and institute immediate empirical anti-tuberculosis treatment when a diagnosis of tuberculosis is suspected. Waiting for a confirmatory test like the urine culture on Lowenstein-Jensen media or histological diagnosis of acid-fast bacilli would take too long and would be detrimental to the patient. Tuberculosis responds well to anti-tuberculous treatment (eg, rifampin, isoniazid, pyrazinamide, and ethambutol or streptomycin).
Therefore, the message is clear that all doctors should be made aware of the emerging scourge of tuberculosis and the different presentations or complications that tuberculosis can manifest. Indeed, early and proper treatment saves lives.
- Sallami S, Gargouri MM, Tayeb M, Slima MB, Makhlouf M. Spontaneous intraperitoneal perforation of the bladder secondary to tuberculosis. UroToday Int J. 2010 Oct;3(5).
- Ho CCK, Ali SA, Singam P, Hong GE, Cheok LB, Zainuddin ZM. Spontaneous bladder perforation: a rare complication of tuberculosis. Int J Infect Dis. 2010;14(Suppl 3):e250-e252.
PubMed ; CrossRef
- Kumar RV, Banerjee GK, Bhadauria RPS, Ahlawat R. Spontaneous bladder perforation: an unusual management problem of tuberculous cystitis. Aust N Z J Surg. 1997;67(1):69-70.
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