Fernando Arias, MD, FACS, Alma Burbano, Natalia Cortes M, Camilo Cetares, MD, Sergio Caceres, MD, Jose Daniel Guerra, MD. Fundacion Santa Fe de Bogota
We present the case of a previously healthy 23 year old female with abdominal pain, distention, nausea, vomit, diarrhea and fever of acute onset. Six months prior to this event she refers pleuritic chest pain and occasional fever. A cavitated pulmonary lesion on chest CT was found. Complete blood count evidenced lymphopenia, elevated erythrocyte sedimentation rate and an elevated CA 125. A bronchoscopy was perform and the lavage was negative. She developed ascites that was analyzed via paracentesis with a positive ADA. A CT scan revealed peritoneal thickening and a omental cake. Peritoneal TB was suspected and also a malignant mesothelioma was consider in the differential diagnosis. A single site laparoscopy (LESS) approach was performed for definitive diagnosis. Findings were a severe peritonitis with adhesions of the viscera with a friable serosa, the greater omentum was attached to the anterior abdominal wall, with fibrinoid membranes and loculated ascites. Multiple biopsies were performed, which were positive for Mycobacteria. A test for infection with the human immunodeficiency virus was negative. The sensitivity of ascitic-fluid culture for M. tuberculosis is low, and the diagnosis can require peritoneal biopsy. The patient was started on TB standard treatment with a favorable outcome.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95893
Program Number: P633
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster