Extensive surgery for peritoneal tuberculosis, an ongoing diagnostic challenge in resource limited setup

Background: Peritoneal Tuberculosis is an abdominal form of Tuberculosis that affects the peritoneal cavity and enclosed organs. Clinical presentation of this rare form of extrapulmonary tuberculosis resembles that of advanced ovarian cancer and may results in unnecessary extensive surgery especially in resource limited setting. Case presentation: A case of a 36 years old prisoner who presented to us with gradual onset of abdominal distension for one-month, mild abdominal pain and noticeable progressive weight loss. Physical examination revealed she was underweight, afebrile and had a healed sub umbilical median incision scar on a glossily distended abdomen with positive fluid thrill and shifting dullness. She was HIV negative, anemic and had marked elevation of Cancer Antigen 125 marker. Abdominal ultrasound scan showed ascites with multiple cysts originating from the left iliac fossa and the abdominal pelvic CT scan showing left ovarian cyst, ascites of 3 litres and diffuse peritoneal carcinomatosis. Advanced ovarian cancer was suspected and intra-operatively 2.5 liters of straw colored ascitic fluid was found, the bowels and the omentum were covered with diffuse intestinal nodules and multiple inclusion cysts occupying the pelvic cavity. Histopathological analysis of sampled tissues revealed Peritoneal Tuberculosis. Conclusion: Peritoneal tuberculosis shares similarities in presentation to advanced ovarian cancer and should be ruled out in a woman suspected of ovarian cancer before proceeding with surgery. For proper differentiation of the two, histopathological analysis of sampled tissue through frozen section biopsy is the preferred approach in resource limited setup where laparoscopic biopsy or ultrasound guided biopsy is not feasible.