Background: Peritoneal Tuberculosis (TB) is a rare and challenging pathology that can present with ascites but seldom with hemorrhagic ascites. Diagnosis can be challenging owing to nonspecific symptoms and variable result imaging techniques. TB could occur primarily or extrapulmonary with intraabdominal TB accounting for one of the rare forms of extra-pulmonary TB. Abdominal TB can affect any part of the gastrointestinal system with the ileum being the commonest, however, affection of the peritoneum is rare coupled with the fact that hemorrhagic effusion is also a rare presentation; this has resulted in a diagnostic challenge even to the astute surgeon. Aim and Objective: We reported this to highlight the need for vigilance and a high index of suspicion in TB Endemic areas for prompt diagnosis of Intraabdominal TB to prevent Morbidity and mortality. Case Summary: A 31year Hausa Muslim Man, who presented to the Emergency unit with the complaint of a 6months history of recurrent abdominal pain, that is vague with no known aggravating or relieving factors with associated low-grade fever, progressive weight loss, generalized body weakness and anorexia. Three weeks before presentation symptoms worsen with associated progressive abdominal distention, constipation and vomiting of several bouts per day non bilious, non-projectile containing recently ingested feeds. Abdominal Examination findings revealed ascites with features of peritonitis. He was resuscitated and had laparotomy with intraoperative findings of haemorrhagic ascites of 3 litres, and extensive miliary deposits on all the abdominal viscera, abdominal wall, and omentum. No mesenteric lymph nodes. He had an uneventful post-operative recovery. Histology report and ascitic fluid cytology showed chronic granulomatous inflammation and inflammation respectively. He was commenced on intensive phase of anti TB medication with clinical improvement. Conclusion: Hemorrhagic ascites from peritoneal TB could portend a grave sign, but prompt diagnosis and treatment could have a rewarding outcome.
Ibrahim et al. (Tue,) studied this question.