2013 Volume 33 Issue 5 Pages 905-908
The patient was a 36-year-old male who visited our hospital with the chief complaint of abdominal distention. Massive ascites with a high ADA level of the ascitic fluid and CT evidence of smooth uniform peritoneal thickening were observed, with no specific findings on bacteriological examination of the ascitic fluid. Because of the strong suspicion of tuberculous peritonitis, a diagnostic laparoscopy and biopsy were performed to obtain an accurate diagnosis. The diagnosis of tuberculous peritonitis was confirmed by histopathological examination of biopsy specimens obtained from the tiny white nodules on the peritoneum, which showed epithelioid cell granulomas with Langhans’ giant cells. The patient was successfully treated and cured with a 6-month regimen of isoniazid (INH), rifampicin (RHP), ethambutol (EB) and pyrazinamide (PZA). Although early diagnosis of tuberculous peritonitis is important for effective treatment and reducing the mortality, it is often difficult to make a precise diagnosis from the clinical findings and examinations. An exploratory laparoscopy with biopsy is useful for obtaining an accurate diagnosis.