Tuberculous Peritonitis Associated with Ovarian Teratoma Presenting as Peritoneal Carcinomatosis

Summary 

Objective

Peritoneal tuberculosis (TB) is a fatal disease if not promptly diagnosed. We present a case of unexplained ascites with miliary peritoneal TB and a review of the literature.

Case Report

A 56-year-old woman was admitted to our hospital because of severe abdominal fullness for 20 days. Computed tomography scans of the abdomen showed massive ascites and a huge intrapelvic mass mimicking an ovarian dermoid cyst. Laboratory examinations revealed an elevated serum cancer antigen 125 level of 1,132.9 IU/mL and normal chest roentgenographic findings. About 5 L of ascitic fluid and many superficial whitish miliary deposits on the intra-abdominal and pelvic surfaces were found during exploratory laparotomy. A right ovarian cystic mass measuring 15 × 14 × 10 cm in size was noted and removed. Pathologic studies of the cyst revealed a mature cystic teratoma, and all the specimens from the peritoneum and the ovarian surface had chronic granulomatous inflammation with central caseous necrosis compatible with TB. She received postoperative anti-TB chemotherapy and was doing well 5 months after surgery.

Conclusion

Tuberculous peritonitis is not easy to diagnose. We suggest that tuberculous peritonitis associated with ovarian teratoma should be included in the differential diagnosis of peritoneal carcinomatosis.

Key Words:  ascites , ovarian teratoma , tuberculous peritonitis

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