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[Tuberculous Peritonitis Requiring Differentiation from Peritoneal Dissemination in a Case with Transverse Colon

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  • 1Dept. of Surgery, Saiseikai Niigata Kenoh Kikan Hospital.

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Summary

This case highlights the critical distinction between tuberculous peritonitis and cancerous peritonitis in a patient initially diagnosed with colon cancer. Prompt anti-tuberculosis treatment enabled safe surgical management.

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Surgical Oncology

Background:

  • A 77-year-old woman presented with symptoms suggestive of advanced colon cancer.
  • Initial intraoperative findings indicated potential peritoneal carcinomatosis.
  • Diagnostic challenges arose due to the absence of intraoperative pathology services.

Purpose of the Study:

  • To report a case of misdiagnosed tuberculous peritonitis initially suspected as colon cancer metastasis.
  • To emphasize the importance of differentiating between tuberculous and carcinomatous peritonitis.
  • To illustrate successful surgical and medical management of tuberculous peritonitis.

Main Methods:

  • Laparoscopic colectomy with biopsy of peritoneal nodules.
  • Pathological examination revealing granulomatous tissue with caseous necrosis.
  • Initiation of standard 4-drug anti-tuberculosis therapy.
  • Delayed laparoscopic transverse colon resection with D3 lymphadenectomy.

Main Results:

  • Pathology confirmed tuberculous peritonitis, not carcinomatous peritonitis.
  • Anti-tuberculosis therapy was successfully administered.
  • The patient underwent delayed laparoscopic colectomy and lymphadenectomy without complications.
  • The laparoscopic procedure was safely completed.

Conclusions:

  • Differentiating tuberculous peritonitis from carcinomatous peritonitis is crucial for appropriate patient management.
  • Effective infection control measures are necessary when managing Mycobacterium tuberculosis during surgical procedures.
  • This case underscores the successful integration of anti-tuberculosis therapy and surgical intervention.