Peritoneal Tuberculosis: Looking beyond the Typical Pathology


Peritoneal tuberculosis (TbP), an uncommon peritoneal infection, is commonly diagnosed in immigrants from developing countries and represents a substantial proportion of cases of extra pulmonary tuberculosis. The variability in patient presentation and the indolent nature of the infection, combined with limited diagnostic strategies available for TbP, often results in delayed diagnosis. Case: Described herein is the case of a 39 years old male recent immigrant from Mali (West Africa), with no significant medical history that presented to hospital with a four-day history of abdominal pain and swelling. Examination was significant for distended abdomen and shifting dullness. No signs and symptoms suggested pulmonary infection, however, QuantiFERON-TB Gold and purified protein derivative (PPD) test were positive suggesting latent Tb infection. In the absence of pulmonary tuberculosis, a diagnosis of TbP should be established histologically. Laparoscopic biopsy showed granuloma but the typical caseating granuloma of TbP was not seen. Nonetheless, based on the extent of the clinical and laboratory findings, the patient was diagnosed with TbP and anti Tb treatment ensued with successful outcome. Conclusion: The lack of caseating granulomas in the pathology should not rule out a diagnosis of TbP, especially in cases where accompanying evidence suggests some form of Tuberculosis.

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Lewis, O. , Tammana, S. and Sealy, P. (2014) Peritoneal Tuberculosis: Looking beyond the Typical Pathology. Open Journal of Internal Medicine, 4, 1-6. doi: 10.4236/ojim.2014.41001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Yeh, H.F., Chiu, T.F., Chen, J.C. and Ng, C.J. (2012) Tuberculous Peritonitis: Analysis of 211 Cases in Taiwan. Digestive and Liver Disease, 44, 111-117.
[2] Khan, F.Y., Al-Muzrakchi, A.M., Elbedawi, M.M., Al-Muzrakchi, A.A. and Al Tabeb, A. (2012) Peritoneal Tuberculosis in Qatar: A Five-Year Hospital-Based Study from 2005 to 2009. Travel Medicine and Infectious Disease, 10, 25- 31.
[3] Demir, K., Okten, A., Kaymakoglu, S., Dincer, D., Besisik, F., Cevikbas, U., et al. (2001) Tuberculous Peritonitis— Reports of 26 Cases, Detailing Diagnostic and Therapeutic Problems. European Journal of Gastroenterology & Hepatology, 13, 581-585.
[4] Lee, W.K., Van Tonder, F., Tartaglia, C.J., Dagia, C., Cazzato, R.L., Duddalwar, V.A., et al. (2012) CT Appearances of Abdominal Tuberculosis. Clinical Radiology, 67, 596-604.
[5] Fedotin, M.S. and Brewer, D.L. (1972) Noncaseating Tuberculous Peritonitis. Archives of Internal Medicine, 130, 920-922.
[6] Vardareli, E., Kebapci, M., Saricam, T., Pasaoglu, O. and Acikalin, M. (2004) Tuberculous Peritonitis of the Wet Ascitic Type: Clinical Features and Diagnostic Value of Image-Guided Peritoneal Biopsy. Digestive and Liver Disease, 36, 199-204.
[7] Marshall, J.B. (1993) Tuberculosis of the Gastrointestinal Tract and Peritoneum. The American Journal of Gastroenterology, 88, 989-999.
[8] Manohar, A., Simjee, A.E., Haffejee, A.A. and Pettengell, K.E. (1990) Symptoms and Investigative Findings in 145 Patients with Tuberculous Peritonitis Diagnosed by Peritoneoscopy and Biopsy over a Five-Year Period. Gut, 31, 1130-1132.
[9] Guirat, A., Koubaa, M., Mzali, R., Abid, B., Ellouz, S., Affes, N., et al. (2011) Peritoneal Tuberculosis. Clinics and Research in Hepatology and Gastroenterology, 35, 60-69.
[10] Sanai, F.M. and Bzeizi, K.I. (2005) Systematic Review: Tuberculous Peritonitis—Presenting Features, Diagnostic Strategies and Treatment. Alimentary Pharmacology & Therapeutics, 22, 685-700.
[11] Akhan, O. and Pringot, J. (2002) Imaging of Abdominal Tuberculosis. European Radiology, 12, 312-323.

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