Incidental Detection of Miliary Tuberculosis During Laparoscopic Cholecystectomy: A Case Report

Miliary tuberculosis is a rare but potentially severe form of disseminated tuberculosis resulting from the hematogenous spread of Mycobacterium tuberculosis, leading to the widespread granulomatous involvement of multiple organ systems. Peritoneal tuberculosis represents an uncommon manifestation of extrapulmonary tuberculosis and often presents with vague and nonspecific clinical features, frequently mimicking intra-abdominal malignancies and posing a significant diagnostic challenge. We report the case of a 24-year-old immunocompetent female patient who presented with symptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy. Intraoperatively, multiple whitish, millet-sized nodules were incidentally identified over the peritoneum, liver surface, and omentum. Histopathological examination confirmed caseating granulomatous inflammation consistent with tuberculosis. The patient was subsequently started on anti-tubercular therapy and showed good clinical improvement on follow-up. This case highlights the importance of intraoperative vigilance, the role of laparoscopy, and the necessity of histopathological confirmation in differentiating tuberculosis from malignancy in endemic regions.