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Arch Surg. 2007;142(12):1220.

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Answer: Tuberculous Peritonitis

The intraoperative findings, including multiple diffuse involvement of the visceral and parietal peritoneum, white military nodules, ascites, violin string–like fibrinous strands, and omental thickening, as shown herein, typically signify the diagnosis of tuberculous peritonitis. Granulomatous inflammation of the peritoneum with multinucleated giant cells was also demonstrated microscopically. Acid-fast bacilli were found. Fibrous tuberculous peritonitis was confirmed. The patient recovered by using 4 combined antituberculous medications.

The first reported case of tuberculous peritonitis dates back to 1843.¹ Approximately 3.5% of patients with pulmonary tuberculosis have tuberculous peritonitis.² It represents 2% of the causes of ascites.³ According to a summary of 11 series,⁴ 25% to 83% of cases of tuberculous peritonitis are associated with pleuropulmonary tuberculosis. Sixty-two percent of patients have alcoholic liver disease. Continuous ambulatory peritoneal dialysis and human immunodeficiency virus are other risk factors.

Although recognized early historically, the diagnosis of tuberculous peritonitis still poses significant challenges. Clinical features, including . . . [Full Text of this Article]

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Arch Surg. 2007;142(12):1219.
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