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

A 77-year-old woman with a diagnosis of transverse colon cance(r cT2N0M0, cStage Ⅰ), who presented with significant weight loss, underwent a planned laparoscopic colectomy. Intraoperative findings revealed multiple small white nodules suggestive of peritoneal dissemination. Due to the absence of a pathologist, rapid intraoperative pathology could not be performed, and only a biopsy of the peritoneal nodules was obtained. Subsequent pathological examination identified granulomatous tissue with caseous necrosis, leading to a diagnosis of tuberculous peritonitis. Standard 4-drug anti-tuberculosis therapy was initiated on postoperative day 7. A laparoscopic transverse colon resection with D3 lymphadenectomy was performed on postoperative day 73. This case emphasizes the importance of differentiating tuberculous peritonitis from carcinomatous peritonitis, as well as the need for appropriate infection control measures in managing Mycobacterium tuberculosis during surgery. The laparoscopic procedure was safely completed with successful management of tuberculous peritonitis.