title: Peritoneal tuberculosis--an uncommon disease that may deceive the gynecologist.
abstract: OBJECTIVE
  To document women with peritoneal tuberculosis mimicking ovarian malignancy and to review pertinent literature.
  
  
  METHODS
  The records of women with peritoneal tuberculosis who were managed at the Soroka Medical Center, Beer-Sheva, Israel between January 2000 and December 2001 were reviewed.
  
  
  RESULTS
  Four patients with peritoneal tuberculosis mimicking ovarian malignancy were encountered. Two presented with the classical symptomatology of advanced-stage ovarian carcinoma including ascites, abdominopelvic masses and elevated serum CA-125, and two presented with lower abdominal pain and adnexal mass. Laparoscopy in one patient and laparotomy in three patients revealed peritoneal tuberculosis and no malignancy. Of the three patients who had laparotomy, two underwent unnecessary extended surgery including total hysterectomy, bilateral salpingo-oophorectomy, omentectomy and bilateral pelvic lymphadenectomy, and one had conservative surgery including unilateral salpingo-oophorectomy. All patients were postoperatively treated with quadruple anti-tuberculosis chemotherapy.
  
  
  CONCLUSIONS
  Medical awareness of peritoneal tuberculosis is still lacking and many women with this disease are initially thought to have ovarian malignancy and undergo unnecessary extended surgery. Laparoscopy including biopsies seems to be a sufficient and safe method to provide diagnosis of peritoneal tuberculosis. If laparoscopy is not feasible, laparotomy should be performed. If no malignancy is detected and the diagnosis of peritoneal tuberculosis is confirmed, unnecessary extended surgery is avoided and anti-tuberculosis treatment is started.
authors.affiliation: Unit of Gynecologic Oncology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer-Sheva, Israel. piura@bgumail.bgu.ac.il
authors.forename: Benjamin
authors.initials: B
authors.lastname: Piura
authors.forename: Alex
authors.initials: A
authors.lastname: Rabinovich
authors.forename: Elad
authors.initials: E
authors.lastname: Leron
authors.forename: Ilana
authors.initials: I
authors.lastname: Yanai-Inbar
authors.forename: Moshe
authors.initials: M
authors.lastname: Mazor
mesh_terms: D015746:Abdominal Pain; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D018394:CA-125 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007557:Israel; D007585:Jews; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D010051:Ovarian Neoplasms; D010052:Ovariectomy; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D000995:Antitubercular Agents; D018394:CA-125 Antigen