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Atypical Presentation of Tuberculous Peritonitis: A Case Report
Nafiye URGANCI, Reyhan GÜMÜŞTEKİN, İnci Pınar SEÇİNTİ
SBÜ Şişli Hamidiye Eğitim Araştırma Hastanesi, Çocuk Gastroenteroloji Kliniği, İstanbul, Türkiye

In today's developing countries, tuberculosis is still an important health problem. Tuberculous peritonitis is a subacute disease and patients can apply with nonspecific symptoms such as abdominal pain and abdominal bloating. In this article, we present a case of tuberculous peritonitis, which is presented with swelling in the abdomen and is diagnosed after laparoscopic examination.

Twelve-year-old female patient was admitted with a sudden onset swelling in her abdomen. No pathology was detected in other systems except respi-ratory sounds decreased in both lung baselines of the case that appeared pale and fond by physical examination. Paracentesis, performed due to high level of acute phase reactants and diffuse ascites by ultrasonographic examination revealed blurred color, high protein content and no atypical cells. PPD and quantiferon test were negative and serum CA-125 level was high. Laparoscopic examination is performed in order to distinquish between malignancy and tuberculosis, it revealed healthy ovaries, tubal adhesions and peritoneal thickening. Repeated Quantiferon test was positive and adenosineaminase level was detected as high in peritoneal fluid. Peritoneal biopsy material revealed chronic granulomatous inflammation caseous necrosis in the histopathological examination. Tuberculosis was not detected in detailed family history and screening. The case was diagnosed with tuberculous peritonitis regarding to imaging and histopathological examination and antituberculous treatment was started by referral to the clinic for infectious diseases.

In case of unexplained abdominal pain and ascites presence, tuberculosis should be considered firstly in our country and laparoscopic examination should be performed and treatment should be started in cases where laboratory examinations are not guiding.


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