Pitfalls of diagnostic laparoscopy in abdominal tuberculosis

A Case of Peritoneal Tuberculosis Mimicking Ovarian Cancer in a Young Female

Background

Tuberculosis causes significant morbidity and mortality globally. Peritoneal tuberculosis can have a similar presentation to ovarian cancer.

Case

We present a case of a 42-year-old female referred to gynecology oncology with imaging findings of enlarged right ovary, omental caking, and elevated CA-125 (1289 U/mL). A diagnostic laparoscopy revealed diffuse studding of intraperitoneal surfaces. Histopathological examination of omental and abdominal wall biopsies showed granulomas, but stains and cultures for mycobacteria were negative. Antimicrobial treatment for tuberculosis was initiated. Within eight weeks, there was clear clinical and radiographic improvement, consistent with a diagnosis of peritoneal tuberculosis.

Conclusion

This case highlights the importance of including peritoneal tuberculosis in the differential diagnosis when evaluating for ovarian cancer in women with epidemiologic risk factors for tuberculosis.

A rare cause of small bowel obstruction: Abdominal cocoon

INTRODUCTION

The clinical manifestations of abdominal 'cocoon' are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel.

PRESENTATION OF CASE

A 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal 'cocoon' which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up.

DISCUSSION

Abdominal 'cocoon' is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively.

CONCLUSION

Abdominal 'cocoon' should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.