A CASE OF TUBERCULOUS PERITONITIS WITH DIFFICULTY IN DIFFERENTIAL DIAGNOSIS

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  • 鑑別診断が困難であった結核性腹膜炎の1例

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Abstract

Tuberculous peritonitis is now a rare disease in Japan. It lacks specific symptoms, and hence presents difficulty in diagnosis. We experienced a case of tuberculous peritonitis diagnosed by an exploratory laparotomy. A 27-year-old woman was admitted to the hospital because of fever, abdominal distension, and abdominal pain. Abdominal CT scan and ultrasonography revealed ascites. The aspirated ascitic fluid was an exudate, but cytology and bacterial cultures were negative. The ascitic fluid showed high level of ADA activity, but was negative for tubercle bacilli on smear microscopy and PCR method. Carcinomatous peritonitis due to ovarian carcinoma was suspected, because of the high level of serum CA-125. Scince the patient did not respond to conservative therapy, an exploratory laparotomy was performed. Operative findings showed thickened omentum, fibrinous adhesion between intestinal loop, and broad fibrin on parietal peritoneum. The thickened omentum and the appendix covered with white belag were resected. Histological examination comfirmed the diagnosis of tubercu-lous peritonitis. After anti-tuberculous therapy was started, the patient satisfactorily improved. Tuberculous peritonitis should be taken into consideration in differential diagnosis from carcinomatous peritonitis.

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