Leo Yamada1, Shinji Ohki1, Daisuke Ujiie1, Takahiro Sato1, Takkeshi Tada1, Hiroyuki Hanayama1, Kenji Gonda1, Zenichiro Saze1, Tomoyuki Momma1, Hirokazu Okayama1, Wataru Sakamoto1, Hisahito Endo1, Shotaro Fujita1, Tomohiro Kikuchi1, Azuma Nirei1, Motonobu Saito1, Koki Kuwabara2, Eisei Endo1, Koji Kono1. 1Department of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University, 2Shirakawa Hospital
Background: In Japan, compared with other asian countries, the number of tuberculosis patients is under control (morbidity incidence rate 14.4) and relatively it’s difficult to find tuberculous peritonitis(0.04-0.5% in all the tuberculosis patients).
But recent global process of people passing could make it happen to import the unaccustomed disease. Like our case tuberculosis peritonitis is no exception.
Here we present a case report of tuberculous peritonitis and using diagnostic laparoscopy, we could make a diagnosis with minimally invasive procedure and could make it possible to treat immediately.
Case presentation: A 30-year-old man from Myanmar with past medical history of pulmonary tuberculosis at the age of three. He admitted to our institution with right lower abdominal pain, fatigue and slight fever lasting for several weeks. Blood test and abdominal ultrasound revealed the increase of inflammatory response (WBC7200, CRP13), high score of CA125 and ascites.
With additional CT scan, not only ascites, panniculitis with peritoneal nodules and the thicken omentum were detected.
Considering the possibility of tuberculous peritonitis and carcinomatous peritonitis, we performed a diagnostic laparoscopy in negative pressure room for preventing from perioperative contamination.
The operative findings, ascites with slightly cloudy, thickened omentum, a few millimeters of white nodules around the peritoneal and omentum were found.
Pathological diagnosis with the omental tissue during operation suggested a suspicion of tuberculous peritonitis due to the caseating granuloma, we could start the treatment with 4 kinds of antitubercular agents (INH+REP+PZA+EB).
Sensitive Mycobacterium tuberculosis was detected from the omental tissue culture after few weeks although both ascites culture and PCR were negative and ADA was under the reference value.
Conclusion: The complication of active pulmonary tuberculosis is about 10% and only pulmonary and pharyngeal tuberculosis are said to be highly contagious, but the report of tuberculosis peritonitis is also rare in the aspect of infectious prevention.
To determine the diagnosis, the detection of Mycobacterium tuberculosis is required from ascites culture or omental biopsy.
The diagnostic laparoscopy might be one of the effective method, because the former sensitivity is only 10-34%, on the contrary the later has precise sensitivity(93%).
In addition, the intraperitoneal features of tuberculosis peritonitis such as “cheese cake sign” are very characteristic.
We report our case of tuberculosis peritonitis, along with some literature review.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94185
Program Number: P636
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster