Pyoperitoneum Secondary to Paraspinal Cold Abscess Rupture

Pyoperitoneum or pus in the abdominal cavityis a rare condition resulting from infected wounds in the abdomen or rupture of an abscess. It is a potentially serious medical condition with high mortality. Tuberculosis is known to cause ascites and abdominal adhesions. It may also cause abscess in intra-abdominal organs like spleen. However, pyoperitoneum secondary to tuberculosis is very rare. We here report a case of a young 26 year old Indian female with no comorbid illness presenting with tubercular pyoperitoneum. She presented with progressive abdominal pain and fever. Ultrasonography showed exudates and floating debris in abdominal cavity. The pus tested positive for AFB in ZN stain. She also had neurological signs for which MRI was done which revealed Pott's spine with surrounding leaking abscess. Thus the pyoperitoneum was secondary to rupture of paraspinal cold abscess.The patient was treated with immediate peritoneal lavage followed by four drug oral anti-tubercular therapy. She responded to the treatment with slow disappearance of abdominal exudates; however the neurological signs remained. The case is reported for its rarity. This is probably the first such case to be reported from India. Relevant literature regarding pyoperitoneum is also discussed at length.