LAP Intraperituneal TB

Case Report: A 25-year Afghan woman with history of three normal vaginal delivery was referred with manifestations of abdominal pain, abdominal swelling, night sweating, decreased appetite and decreased weight and sonographic findings of massive ascites and cystic mass of right ovary. Physical examination revealed ascites and sublingual temperature of 38.5 oC. Vaginal sonography showed a cyst with diameter of 4.7 cm in the right ovary. Massive pleural effusion, especially in right side, was seen in chest x-ray. Spiral CT scan of abdomen and pelvis revealed massive ascites, omental cake and severe bowel adhesions in favor of malignant epithelial tumors of ovary. Laboratory exam showed as following: CA 125= 853, LDH= 852, ESR= 80, HB =10.5, low MCH and high levels of AST and ALT. Pleural and ascites tap under guide of CT scan was negative for cytology and culture of tuberculosis. Despite negative results of culture of tuberculosis and PPD, high ADA in pleural fluid strongly suggested abdominal tuberculosis. Laparoscopy was done for preparation of tissue sampling and finding definite diagnosis. According to severe bowel adhesion, first trocar was inserted by open technique and 3- cm incision from left sub-costal region. Intra- peritoneal miliary like lesions and adhesion within abdomen and pelvis were noted. Ascites fluid was removed and multiple biopsies were taken from different part of peritoneum. Detection of necrotic granuloma in pathologic studies confirmed diagnosis of abdominal military tuberculosis. The patient received 4- drug anti tuberculosis regimen