Case Study - Ttberculosis in the peritonneum: a not too rare form

Abstract

Tuberculosis (TB) is a major public health problem globally. Few decades back it was quite common and gynaecologists managed patients with either peritoneal TB or genitourinary TB. It is very rare to find a patient with such complications in current medical practice. Although WHO reports a reduction in overall incidence of TB, the prevalence and the number of deaths due to TB still remains high. The abdominal form of TB is the sixth leading site of extra pulmonary TB, after lymphatic, genitourinary, osteoarticular, miliary and meningeal TB.

Case history - A young Sri Lankan woman presented to a medical ward with generalized abdominal pain. She complained of loss of appetite and abdominal distension without loss of weight. Haematological and biochemical investigations and ultra sound scan of abdomen were performed. The scan revealed ascites and other test were within normal limits. The patient was referred to the gynecology team for further management. Diagnostic laparoscopy revealed peritoneal seedlings covering all the aspects of peritoneum and almost all abdominal viscera. Multiple firm nodules were biopsied which lead to the diagnosis of peritoneal TB.

This case illustrates an unusual presentation of widespread peritoneal tuberculosis which is very rare in routine clinical practice. This type of patient can present to any medical speciality but the diagnosis and the management may be delayed if the clinician does not take into consideration the possibility of extra pulmonary TB as a possible diagnosis in a patient presenting with ascites