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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 122-123

Abdominal tuberculosis discovered during routine laparoscopy


Consultant at Institute of Reproductive Medicine and Women's Health, Madras Medical Mission, Chennai, Tamil Nadu, India

Date of Submission05-Jan-2019
Date of Acceptance11-May-2019
Date of Web Publication19-Jun-2019

Correspondence Address:
Abdul Basith
Old No. 9, New No. 4, Barnaby Avenue, Kilpauk, Chennai - 600 010, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_13_19

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  Abstract 


Tuberculosis is a critical problem in India. There has been a recent rise in the incidence of genital tuberculosis which is usually asymptomatic and discovered only when the married woman presents to the infertility clinic. We report one such patient who had a diagnostic laparoscopy for infertility evaluation and was diagnosed to suffer from disseminated abdominal tuberculosis probably from genital tuberculosis.

Keywords: Abdominal tuberculosis, genital tuberculosis, infertility, laparoscopy


How to cite this article:
Basith A. Abdominal tuberculosis discovered during routine laparoscopy. Apollo Med 2019;16:122-3

How to cite this URL:
Basith A. Abdominal tuberculosis discovered during routine laparoscopy. Apollo Med [serial online] 2019 [cited 2019 Aug 18];16:122-3. Available from: http://www.apollomedicine.org/text.asp?2019/16/2/122/260682




  Introduction Top


We present a case of florid abomino-peritoneal tuberculosis discovered during routine laparoscopy for infertility evaluation. On further testing, tuberculosis was proved and she underwent anti tuberculosis treatment.


  Case Report Top


A 27-year-old woman presented to our subfertility outpatient department, anxious to conceive, trying for 3 years. She had a history of scanty irregular period, vague lower abdominal pain not related to the cycles, loss of appetite, and weight loss. She complained of vaginal dryness and dyspareunia. She had no interest in sex. Her previous evaluation showed confirmed ovulation. Her tubal assessment was not done. Her husband's semen analysis was normal.

She was posted for diagnostic laparoscopy and chromopertubation as part of the infertility assessment.

Laparoscopy was done with Veress at the Palmer's point with the primary port placed through the Palmer's point. On entering the abdominal cavity, we found multiple small tubercles studded all over the peritoneal surfaces and intra-abdominal organs [Figure 1]. The uterus, bilateral tubes, and ovaries were studded with these tubercles [Figure 2] and [Figure 3]. We considered either primary peritoneal cancer or abdominal tuberculosis (TB). Multiple peritoneal biopsies were taken and sent for histopathology. The report came back as caseation granulomas, suggestive of TB. The BACTEC™ culture revealed TB.
Figure 1: Florid tubercules seen all over the peritoneum

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Figure 2: Tubercules covering the uterine surface, tubes and interstinal serosa

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Figure 3: Tubercules seen all over the peritoneum in the upper abdomen

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  Discussion Top


There are multiple clinical presentations of abdominal TB, which makes diagnosis difficult. One of the recent and emerging presentations is subfertility. As it is usually a disease of young adults, especially in India, we have to consider the diagnosis of abdominal TB always. Further, computed tomography abdomen may have limited role in the diagnosis of abdominal TB.[1] Patients who have peritoneal TB also have additional comorbidities such as diabetes mellitus, HIV, and renal failure.[2] We did not come across any such positive history for this patient, and the patient did not have any past history of pulmonary TB or family history of TB.

The BACTEC Automated Blood Culture System utilizes fluorescent technology in detecting the growth of organisms in blood culture bottles. The WHO recommends daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) for 2 months followed by daily 4-month therapy of rifampicin (R) and isoniazid (H). Alternatively, 2-month intensive phase of RHZE can be daily followed by alternate-day combination phase (RH) of 4 months.[3] The patient is currently undergoing anti-tubercular treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sharma SK, Mohan A, Sharma A. Challenges in the diagnosis & treatment of miliary tuberculosis. Indian J Med Res 2012;135:703-30.  Back to cited text no. 1
  [Full text]  
2.
Kaya M, Kaplan MA, Isikdogan A, Celik Y. Differentiation of tuberculous peritonitis from peritonitis carcinomatosa without surgical intervention. Saudi J Gastroenterol 2011;17:312-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Sharma JB. Current diagnosis and management of female genital tuberculosis. J Obstet Gynaecol India 2015;65:362-71.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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