2019 Volume 39 Issue 4 Pages 755-758
A 68-year-old man, who had uncontrollable ascites and had been treated with diuretics for 6 months, presented with an umbilical bulge and was referred to our hospital for further examination and treatment. Abdominal contrast enhanced computed tomography (CT) revealed a large amount of ascites and a strangulated umbilical hernia involving the small intestine. We performed an emergency operation comprising partial resection of approximately 10 cm of the small intestine and repair of a 3×2 cm hernia orifice with primary closure. There was no peritoneal nodule and ascitic smear, and culture and polymerase chain reaction (PCR) were negative. The levels of adenosine deaminase (ADA) in the ascites was high and the QuantiFERON–TB (QFT) test was positive. We diagnosed the condition as an umbilical hernia due to tuberculous peritonitis. The patient was treated with anti-tuberculous drugs and the ascites disappeared. Tuberculous peritonitis is so rare that it often needs a prolonged examination before diagnosis can be made. Therefore, it may cause secondary acute abdomen require an emergency operation such as in our case. In acute abdomen with refractory ascites, it is important to exam intraoperatively the ascites and peritoneal nodules to arrive at the diagnosis of tuberculous peritonitis.
