Laparoscopic peritoneal biopsy can be crucial for diagnosis of tuberculous peritonitis |
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Authors: | Tomofumi Miura Junichiro Nakamura Satoshi Yamada Tsutomu Miura Masahiko Yanagi Takeaki Nishibori Shinichi Takei Toru Takahashi |
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Institution: | (1) The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan;(2) The Division of Infectious Diseases, Nagaoka Red Cross Hospital, Nagaoka, Japan;(3) The Division of Gastroenterology, Joetsu General Hospital, Joetsu, Japan |
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Abstract: | A 28-year-old woman was admitted to a nearby hospital because of low-grade fever and lower abdominal pain, where ascites and
slightly elevated serum CA125 level were found. Both acid-fast stain (AFS) and polymerase chain reaction (PCR) failed to detect
Mycobacterium tuberculosis in her ascitic fluid, sputum, and gastric juice. She was referred to our division under suspicion of tuberculous peritonitis
or ovarian carcinoma. Finally, diagnostic laparoscopy was carried out, showing yellowish-white small nodules disseminated
on her whole peritoneum with thin fibrous adhesions. Peritoneal biopsy of these nodules showed epithelioid cell granulomas
without caseous necrosis. AFS and PCR again failed to show any evidence of Mycobacterium tuberculosis in these biopsied samples. Based on the laparoscopic findings, however, we thought that she suffered from tuberculous peritonitis.
Antituberculous therapy was started and she improved soon. Later, Mycobacterium tuberculosis was demonstrated in the 4-week culture of a peritoneal biopsy specimen. We conclude that laparoscopy may be the only way
to detect Mycobacterium tuberculosis in tuberculous peritonitis whenever doubtful but no direct evidence is obtained. |
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