Emergency surgery performed in a case of tuberculous peritonitis: perioperative infection control

Abstract

Although tuberculous peritonitis has decreased due to improved public health measures and reduced overall tuberculosis prevalence due to advances in treatment, it is one of the diseases that require an emergent operation. An 82-year old man was admitted to our hospital with abdominal pain and vomiting. The diagnosis of strangulation ileus was posed, and an emergent laparotomy was performed. Ten months prior, he was diagnosed with pulmonary tuberculosis and tuberculous peritonitis and was treated with anti-tuberculosis drugs. Furthermore, he had a history of oral steroid intake and abdominal surgery. Healthcare workers wore N95 masks and performed the surgery in a standard operating room. The cause of the strangulation was adhesions. The operation showed multiple white nodules in the mesentery, of which one was removed and analyzed, and revealed Mycobacterium tuberculosis. After confirming that there was no postoperative infectivity, the negative pressure chamber management was canceled. Although tuberculous peritonitis is generally considered non-infectious, it is essential to take precautions against infection due to aerosol generation during abdominal surgery. It is necessary to pay attention to the medical history, distinguish tuberculous peritonitis from peritonitis cases of unknown etiologies, and have a nosocomial infection control manual for emergency surgery.