A Case of Tuberculous Peritonitis with Enterocutaneous Fistula

Noriyuki Hirahara, Takeshi Nishi, Yasunari Kawabata, Toko Inao, Seiji Yano, Mitsuo Tachibana, Tsuneo Tanaka, Kunihiko Ueda*, Kazuyuki Matsushita* and Ichiro Ogushi*

Department of Digestive and General Surgery, Shimane University School of Medicine
Department of Surgery, Kyowakai Kyoritsu Hospital*

A 55-year-old man admitted for fever, right lower abdominal pain and skin redness was found in laboratory data examination to have marked leukocytosis (13,900/μl) and high C- reactive protein (27.7 mg/dl). Abdominal computed tomography (CT) showed a 10×6×5 cm cystic lesion in the right lower abdominal cavity. The abdominal abscess ruptured the day after hospitalization, and the man was treated with antibiotics and drainage. The drainage wound was closed and he was discharged 8 days after admission. The abscess ruptured again, however, and fistelography showed an enterocutaneous fisutula. Intraabdominal findings during laparotomy showed mucious ascites and multiple small size white indurations in the abdominal cavity. Histological examination of the small indurations showed epitheloid granuloma with caseous necrosis, suggesting tubercular peritonitis. Colonoscopy showed ileocecal erosion leading to a diagnosis of histologically tuberculous peritonitis. Antituberculous agents were administered and abdominal symptoms disappeared. Tuberculous peritonitis should thus be taken into consideration in differentitial diagnosis.

Key words
tuberculous peritonitis, enterocutaneous fistula, laparoscopy

Reprint requests
Noriyuki Hirahara Department of Digestive and General Surgery, Shimane University School of Medicine
89-1 Enya-cho, Izumo, 693-8501 JAPAN

Accepted
January 31, 2007

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