Lahbabi Mounia, Brini Jihane, Massaoudi Khalid
Department of Hepato-gastroenterology, Guelmim, Morocco.
J Med Case Rep. 2014 Jan 2;8:3. doi: 10.1186/1752-1947-8-3.
Tuberculous peritonitis is one of the least common forms of extrapulmonary tuberculosis. In the literature, few cases in pregnancy have been previously published. Tuberculous peritonitis in pregnancy is a diagnostic challenge, especially in the absence of lung involvement. It mimics other diseases and clinical presentation is usually non-specific, which may lead to diagnostic delay and development of complications.
We report here a new case of tuberculous peritonitis that occurred in a 31-year-old Caucasian pregnant woman at 22 weeks' gestation. She was complaining of abdominal pain, nausea and vomiting. These symptoms appeared 6 months prior to presentation. Initially, they were attributed to pregnancy, but they progressively became more severe during subsequent weeks. A laparoscopy showed the presence of yellow-white nodules on the peritoneal surface and a biopsy demonstrated caseous necrotic granuloma. She made a good physical recovery after being placed on antituberculous chemotherapy and gave birth to a healthy male neonate of 3100g at 37 weeks' gestation by vaginal delivery.
Extreme vigilance should be used when dealing with unexplained abdominal symptoms to ensure timely diagnosis of tuberculous peritonitis. Diagnosis often requires a histopathological examination. In these patients early diagnosis with early antituberculous therapy are essential to prevent obstetrical and neonatal morbidity.
结核性腹膜炎是肺外结核最不常见的形式之一。在文献中,此前很少有妊娠合并结核性腹膜炎的病例报道。妊娠合并结核性腹膜炎是一个诊断难题,尤其是在没有肺部受累的情况下。它与其他疾病相似,临床表现通常不具有特异性,这可能导致诊断延迟和并发症的发生。
我们在此报告一例新的结核性腹膜炎病例,发生在一名31岁的白人孕妇,妊娠22周。她主诉腹痛、恶心和呕吐。这些症状在就诊前6个月出现。起初,这些症状被归因于妊娠,但在随后几周逐渐加重。腹腔镜检查显示腹膜表面有黄白色结节,活检显示干酪样坏死性肉芽肿。她在接受抗结核化疗后身体恢复良好,并在妊娠37周时经阴道分娩出一名体重3100g的健康男婴。
在处理不明原因的腹部症状时应保持高度警惕,以确保及时诊断结核性腹膜炎。诊断通常需要组织病理学检查。对于这些患者,早期诊断并尽早进行抗结核治疗对于预防产科和新生儿发病至关重要。