PERITONEAL TUBERCULOSIS IN YOUNG AGE LADY MIMICKING GYNECOLOGY MALIGNANCY : A CASE REPORT
(1) Obstetrics and Gynecology Department, Faculty of Medicine, Universitas Andalas, Padang
(2) Oncology Ginecology Division of Obstetrics and Gynecology Department, Faculty of Medicine Universitas Andalas, Padang
(3) Oncology Ginecology Division of Obstetrics and Gynecology Department, Faculty of Medicine Universitas Andalas, Padang
(*) Corresponding Author
DOI: https://doi.org/10.25077/aoj.8.1.653-659.2024
Abstract
Background : Peritoneal tuberculosis is one of the most challenging forms of extrapulmonary
tuberculosis to diagnose. Extrapulmonary TB is very difficult to diagnose because of its non-
specific signs and symptoms, thus it sometimes leads to a diagnosis of gynaecological
malignancy such as advanced ovarian carcinoma.
Case Report : A teenage girl, 12 years old, with a chief complaint of intermittent abdominal
pain since the last 1 month. There was no history of an enlarged abdomen, fever and weight
loss. Ultrasound examination revealed an irregular adnexal mass suggesting an ovarian
malignancy with other possibilities of an infectious process. Diagnostic laparoscopy and
peritoneal biopsy were performed on the patient. Intraoperatively, multiple friable nodular-
mylar peritoneal masses with abdominopelvic attachments and fibrin fibres and white vesicles
were found on the entire surface of the genitalia, peritoneum, and intestines. A mass biopsy
was performed with histopathological results showing peritoneal tuberculosis. Currently, the
patient is undergoing anti-tuberculosis drugs (OAT) treatment.
Discussion : The diagnosis of this disease is difficult to establish. Symptoms are highly
variable and non-specific and can lead to the wrong tumour pathology. The clinical
characteristics are dominated by changes in general condition, abdominal pain and transit
disorders, as well as masses (20 to 25%). The gold standard for definitive PTB diagnosis
remains laparoscopy with peritoneal biopsy and subsequent pathological or microbiological
confirmation. Yellow/white nodules in the peritoneum observed on the patient's laparoscopic
images are the hallmark of wet peritoneal TB. Omental thickening and abdominal cocoon with
matted small bowel are other classic laparoscopic findings for peritoneal TB.
Conclusion : PTB has similar characteristics to peritoneal carcinoma, which makes diagnosis
difficult for clinicians. Early and correct diagnosis of PTB helps to initiate medical management
quickly and helps reduce morbidity and mortality.
Keywords
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