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Case Reports
. 2020:72:326-329.
doi: 10.1016/j.ijscr.2020.06.046. Epub 2020 Jun 13.

Tuberculous peritonitis; The effectiveness of diagnostic laparoscopy and the perioperative infectious prevention: A case report

Leo Yamada  1 , Motonobu Saito  2 , Tetsuro Aita  3 , AungKyiThar Min  2 , Eisei Endo  2 , Koji Kase  2 , Daisuke Ujiie  2 , Hiroyuki Hanayama  2 , Hirokazu Okayama  2 , Wataru Sakamoto  2 , Hisahito Endo  2 , Shotaro Fujita  2 , Zenichiro Saze  2 , Tomoyuki Momma  2 , Shinji Ohki  2 , Sugihiro Hamaguchi  3 , Koji Kono  2
Affiliations
Case Reports

Tuberculous peritonitis; The effectiveness of diagnostic laparoscopy and the perioperative infectious prevention: A case report

Leo Yamada et al. Int J Surg Case Rep. 2020.

Abstract

Background: Tuberculous peritonitis (TBP) is uncommon in Japan, and its diagnosis with conventional methods is time taking and requires a high clinical index of suspicion. Laparoscopy with peritoneal biopsy is a tool for rapid and accurate diagnosis of TBP. However, few cases have mentioned the infectious control and prevention during the perioperative period. This case is written following the SCARE scale for case report writing.

Case presentation: A 30-year-old man from Southeast Asia with a past medical history of pulmonary tuberculosis at 3-year-old admitted to our institution with abdominal pain and slight fever lasting for a week. With the elevation of inflammatory response and CA125, we conducted CT (Computed tomography). Not only ascites, panniculitis with peritoneal nodules, and the thickening of the omentum were found. Considering the possibility of malignancy and TBP, we performed a diagnostic laparoscopy. Slightly cloudy ascites, peritoneal and thickening omentum with white nodules were seen, and pathological diagnosis from the omentum during the operation raised the possibility of TBP due to its caseating granuloma and these findings allowed us to start the rapid treatment.

Conclusion: We reported the effectiveness of diagnostic laparoscopy along with the aspect of perioperative prevention for TBP.

Keywords: Diagnostic laparoscopy; Laparoscopic features; Minimal invasion; Perioperative infection control; Tuberculous peritonitis (TBP).

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Figures

Fig. 1
Fig. 1
Chest-abdominal computed tomography showing ascites fluid, and panniculitis with peritoneal nodules (white arrows) and the thicken of the omentumn(yellow allows).
Fig. 2
Fig. 2
Scheme of ports position attempted to avoid the adhesion area (a). Numerous white nodules (a few millimeters) at the abdominal wall and omentum (b). Ascites fluid with slightly cloudy at the both paracolic and thicken omentum with white nodules (c). Obtaining historical specimens from peritoneum and omentumn using Ultrasonic incision coagulating device (d).
Fig. 3
Fig. 3
Microscopic findings of peritoneal biopsy specimens (H&E). Chronic granulomatous inflammation with central necrosis (white arrow) and Langhans giant cell (yellow arrow) were seen, which suggested tuberculous peritonitis (×200).
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