癌性腹膜炎との鑑別を要し、腹腔鏡下に診断し得た結核性腹膜炎の1例

概要

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Primary peritoneal tuberculosis is a rare disease that may mimic peritoneal carcinomatosis because of similar clinical pictures, including radiologic and laboratory test results. The differential diagnosis requires consideration of a wide range of benign and malignant gynecologic and gastrointestinal candidate conditions. A 74-year-old woman was referred to our hospital and presented with ascites and left ovarian cysts. The concentration of CA125 in the serum was 230.7 U/mL. Transvaginal paracentesis revealed that cytology of ascites was negative for cancer, but magnetic resonance imaging (MRI) and computed tomography (CT) suggested possible peritoneal dissemination. We performed bilateral salpingo-oophorectomy and peritoneal biopsy by laparoscopy and found multiple miliary deposits on the peritoneal surface, the Pouch of Douglas, most of the intestine, liver, and diaphragm. Upon histological examination, epithelioid granulomatous lesions with necrosis were apparent. No cancer cells were found in either the ovaries or fallopian tubes. Therefore, a diagnosis of peritonitis tuberculosis was established, and <I>Mycobactrerium tuberculosis</I> was later identified in cultures of the peritoneum. Herein, we have demonstrated an effective and minimally invasive procedure for diagnosing peritoneal tuberculosis via laparoscopy.