Tuberculose péritonéale: aspect laparoscopique de pelvis gelé

Abstract

The present study reports the case of a 38-year old female patient who was referred to us by the gastroenterology team for the exploration of high abundance ascites occurred 1 month before. The patient had no particular past medical history, no history of prolonged fever or tuberculosis. She had two living children born vaginally and a regular 28-day cycle. Abdominal ultrasound appeared normal apart from the high abundance peritoneal effusion. Removal of the ascites fluid by punctation revealed an exudative fluid with no cancerous cells. The patient underwent laparoscopic exploration. An open laparoscopy was performed which allowed the immediate drainage of 4 liters of yellow-citrine fluid. Laparoscopic exploration showed peritoneal cavity completely lined with very fine granulations covering the whole parietal and visceral peritoneum. The exploration of the pelvic floor revealed a completely frozen pelvis associated with fragile uterus and ovaries bleeding at the slightest touch and detectable only because of their prominence. The fallopian tubes and the rest of the pelvic organs were unrecognizable. Biopsies revealed peritoneal tuberculosis. The patient received a combination of 4 antibiotics for 2 months: isoniazid, rifampin, pyrazinamide and ethambutol; then she received a combination of isoniazid and rifampin during the second phase of treatment which lasted for 4 months. The patient ’s evolution was favorable, with total disappearance of the ascites at the end of a three-week treatment.

The Pan African Medical Journal 2016;25