Tuberculous peritonitis

Excerpt

A previously healthy 50-year-old man presented with a one-month history of abdominal distention. He had no known medical history. On physical examination, mild and diffuse abdominal tenderness was observed. Laboratory tests revealed mild anemia and elevated sedimentation rate. A moderate amount of ascites and thickened peritoneum were shown by computed tomographic scan after the administration of contrast material (Fig. 1A). Analyses of ascitic fluid showed a predominance of lymphocytes and an adenosine deaminase level of 47 U per liter (reference range, 0 to 15). Exploratory laparoscopy showed thickened peritoneum with miliary yellowish white tubercles without adhesions (Fig. 1B, C). A specimen of an omental lesion was obtained on biopsy. Peritoneal histopathological analysis confirmed granulomatous inflammation (Fig. 1D). Although mycobacteria were not identified by acid-fast bacillus staining, Deoxyribonucleic acid (DNA) amplification by the polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis was positive. A purified protein-derivative skin test was positive. No tuberculous lesions were found in the lung, intestine, colon and upper gastrointestinal tract. Testing for human immunodeficiency virus (HIV) was negative. A final diagnosis of tuberculous peritonitis was made. Tuberculous peritonitis may occur at any age. Ingestion of bacilli with subsequent passage through Peyer’s patches in intestinal mucosa to mesenteric lymph nodes is the possible route of infection [1, 2]. The treatment of tuberculous peritonitis is primarily medical, which is identical to those of pulmonary tuberculosis. Surgical intervention is reserved for complications, including fistulae, intestinal obstruction, abscesses, bowel perforation and hemorrhage, which arise from adhesions and inflammation [3].

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