Korean J Gastroenterol.  2017 May;69(5):308-311. 10.4166/kjg.2017.69.5.308.

A Case of Tuberculous Peritonitis Presenting as Small Bowel Obstruction

• Kim HK
• Kim SE
• Park MI
• Park SJ
• Moon W
• Kim JH
• Jung K
• Nam YJ

• KMID: 2383389
• DOI: http://doi.org/10.4166/kjg.2017.69.5.308

Abstract

The peritoneum is one of the common extrapulmonary sites of tuberculosis infection. Patients with underlying end-stage renal or liver disease are frequently complicated by tuberculous peritonitis; however, the diagnosis of the tuberculous peritonitis is difficult due to its insidious nature, well as its variability in presentation and limitation of available diagnostic tests. Once diagnosed, the preferred treatment is usually antituberculous therapy in uncomplicated cases. However, surgical treatment may also be required for complicated cases, such as small bowel obstruction or perforation. An 85-year-old woman was referred our hospital for abdominal pain with ileus. Despite medical therapy, prolonged ileus and progression to sepsis were shown, she underwent surgery to confirm the diagnosis and relief of mechanical ileus. Intraoperative peritoneal biopsy and macroscopic findings confirmed tuberculous peritonitis. Therefore, physicians should consider the possibility of tuberculous peritonitis in patients with unexplained small bowel obstruction.

Keyword

Tuberculous peritonitis; Intestinal obstruction; Laparoscopy; Diagnosis

MeSH Terms

Abdominal Pain
Aged, 80 and over
Biopsy
Diagnosis
Diagnostic Tests, Routine
Female
Humans
Ileus
Intestinal Obstruction
Laparoscopy
Liver Diseases
Peritoneum
Peritonitis, Tuberculous*
Sepsis
Tuberculosis

Figure

• 

  Fig. 1 Abdominal X-ray at admission. Distended bowel loop of small bowel and fluid level in erect (A) and supine (B) view.

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  Fig. 2 Abdominal computed tomography showing ascites and diffuse dilation of small bowel but collapsed colon in transverse (A) and coronal (B) view.

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  Fig. 3 Gross finding of the resected specimen. The omentum shows a great amount of small grey-whitish nodules with various sizes (arrows).

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  Fig. 4 Microscopic findings of peritoneal biopsy specimens (H&E). Chronic granulomatous inflammation with central necrosis (arrow) was seen, which was suggestive of tuberculous peritonitis (×100).

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