Caecal perforation from TB and the Law of Laplace

A 43-year-old man presented to the hospital with haemoptysis. When worked up, his history and examination were highly suggestive of pulmonary tuberculosis (TB). He subsequently developed a massive upper gastrointestinal bleed and underwent an emergency laparotomy, which revealed a massively dilated caecum measuring ∼20 cm in diameter. The caecum had perforated due to acute decompensation of intestinal TB. Though common in developing countries, TB is rare in the UK, especially the intestinal kind. The most striking feature of this case is, however, the size of the caecal distension caused by the tubercular inflammation and subsequent perforation—something unheard of in the literature. This massive caecal distention would be explained by the Law of Laplace. In conclusion, massive distension and caecal perforation are possible consequences of intestinal TB, especially in the 48–72 h immediately after starting anti-tubercular therapy.