Tuberculous peritonitis defying diagnosis: Report of a case

A case of tuberculous peritonitis, which has been scarcely encountered in c linical practice in recent years, is reported. A 32-year-old man was admitt ed to our hospital complaining of abdominal fullness, anorexia, and a 15 kg weight loss. His abdomen was distended. There was neither any previous his tory nor recent contact with tuberculosis. The laboratory data indicated in creased C-reactive protein and erythrocyte sedimentation rate, but the whit e blood cell count was normal, A chest X-ray examination revealed no abnorm alities. Abdominal X-ray showed scattered, small-intestinal gas shadows, Ab dominal computed tomography scanning revealed a diffuse thickening of the d ilated bowel wall, mainly adjacent to the mesentery, After a detailed exami nation a diagnosis of peritonitis carcinomatosa of unknown origin was suspe cted, and an exploratory laparotomy was done, Severe adhesions between the parietal peritoneum and the bowel were found. An excisional biopsy specimen was taken from the peritoneum, and a diagnosis of tuberculosis was thus ma de, Triple therapy with isoniazid, rifampicin, and kanamycin was started, a nd both the intestinal obstruction and anorexia were thus resolved.