Peritoneal tuberculosis with an atypical presentation. Surgical case report

1-3% of tuberculosis cases are extrapulmonary, which 11-16% are abdominal. In recent years, a progressive increase in the number of peritoneal tuberculosis cases has been observed. Peritoneal tuberculosis accounts for only 1-2% of all cases of peritonitis. Historically it is known as "the great mimicker" since it can resemble a neoplastic, infectious or inflammatory intestinal disease. The most common triad of presentation is fever, weight loss and abdominal pain; ascites is also usually present. For diagnosis, computed tomography is the most sensitive technique and is complemented by elevation of CA 125 and Adenosine deaminase (ADA) but is confirmed by pathology study. Treatment is the same as the pulmonary presentation.

A 33-year-old man presented with acute complication appendicitis. A limited right hemicolectomy was performed due to the nature of the patient advanced disease. Multiple small tumor resembling peritoneal implant and a granuloma were identified has sampled during the patient's surgical procedure. Pathologic examination revealed peritoneal tuberculosis and medical therapy was initiated. Laboratory assays including CA 125 and adenosine deaminase (ADA) can be useful serum markers to follow during treatment if they are positive.

The most common presentation of peritoneal tuberculosis is fever, weight loss and abdominal pain. Our patient did not have any of these symptoms, we founded granulomas in surgery of intestinal restitution.

The work has been reported in line with the SCARE criteria.

This pathology should always be kept in mind as a differential diagnosis when faced with unexpected findings in surgery.