Tuberculous peritonitis in no risk patients: diagnostic approach.
BACKGROUND
Incidence of tubercoulosis is increasing in Western countries particularly in immigrants from endemic areas and in patients with HIV or immunocompromised. The disease is unusual in patients without risk factors. In these conditions the diagnosis of tuberculous peritonitis is often delayed, resulting in high morbidity and mortality.


METHODS
We describe a case of tuberculous peritonitis in a man suffering from ascites referred for presumed peritoneal carcinosis. The finding of no malignancies in the peritoneal fluid must rise the suspect of tuberculosis that, if misdiagnosed, is fatal. The patient was submitted to diagnostic videolaparoscopy and multiple biopsies were done. The definitive histological diagnosis was chronic granulomatous flogosis with giant cells, focally necrotizing, caused by peritoneal tubercolosis.


RESULTS
The patient was submitted to chemotherapy with isoniazide, rifampicine, piazafoline, ethambutol and streptomycine which determined the resolution of the clinical picture.


CONCLUSIONS
We believe the diagnostic procedure of choice is videolaparoscopy when tubercolous peritonitis is suspected. This technique allows to obtain selective biopsies of peritoneal nodules and to collect samples for specific cultural and cytohistological exams. The operation is safe, reliable with few complications and permits a prompt diagnosis necessary to cure the patient.
Tazzioli
Giovanni
G
Department of General Surgery and Surgical Specialties, University of Modena e Reggio Emilia, Italy. tazzioli.giovanni@unimore.it
Farinetti
Alberto
A
Gelmini
Roberta
R
Longo
Giuseppe
G
Barbolini
Giuseppe
G
Saviano
Massimo
M
D000995:Antitubercular Agents / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000188:drug therapy; D020535:Video-Assisted Surgery
D000995:Antitubercular Agents