A case of tuberculous peritonitis identified during exploratory laparotomy for a perforated peritonitis caused by an intestinal foreign body

Abstract

An 82-year-old man developed a fever and a feeling of abdominal fullness. On abdominal CT scan, a foreign body in the small intestine was found ; a large amount of ascites was also noted. Based on the CT findings and an elevated CRP level, the patient had an exploratory laparotomy given a provisional diagnosis of perforated peritonitis caused by a foreign body. During the laparotomy, a large amount of, yellow, clear, ascitic fluid was found in the abdominal cavity ; multiple small nodules were found on the peritoneal surface of small intestine and the mesentery. The intestinal foreign body was easily found and then removed through a jejunotomy. However, the site of perforation was not identified. The intraoperative pathology report noted multiple small granulomatous formations and miliary findings. As a result, the ascites was thought to be related to tuberculous peritonitis. The postoperative pathology report identified Mycobacterium tuberculosis in the small nodules. Given a diagnosis of tuberculous peritonitis antituberculosis treatment was initiated.