Saito Suruga, Ito Katsuhiro, Matsumoto Keiyu, Tajima Motofumi, Goto Takayuki, Ito Haruki, Manabe Yumi, Mishina Mutsuki, Okuno Hiroshi
Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
J Endourol Case Rep. 2018 Apr 1;4(1):48-50. doi: 10.1089/cren.2018.0018. eCollection 2018.
Peritoneal tuberculosis (TB) is a relatively uncommon presentation of extrapulmonary TB. Early diagnosis of peritoneal TB is difficult because of its nonspecific clinical manifestation such as abdominal pain, fever, or ascites. Especially early after surgery of abdomen or pelvis, these symptoms can be misdiagnosed as septic peritonitis. There are few reports of peritoneal TB as a postoperative complication of laparoscopic surgery. Here, we describe a first case of peritoneal TB after robot-assisted laparoscopic prostatectomy (RALP) with extended lymph node dissection. A 78-year-old man presented 25 days after this surgery with fever and abdominal distension. Ultrasonography and computed tomography (CT) revealed massive abdominal ascites. Ascites sample was cloudy, with increased white blood cells and normal creatinine level. No anastomotic leak was found. Bacterial infection of a lymphocele was considered, and cefmetazole 2 g/day for 3 days was prescribed. Despite antibacterial therapy, fever persisted. Polymerase chain reaction testing of ascitic fluid was positive for . The patient was effectively treated with anti-TB therapy. This is the first report of peritoneal TB as a postoperative complication of RALP with extended lymph node dissection. His preoperative chest CT showed granular shadows in left upper lung, indicating his old asymptomatic TB infection. Flare-up of TB can happen even after robot-assisted laparoscopic surgery, which is minimally invasive. Peritoneal TB must be considered especially when there is unexplained ascites unresponsive to antibiotics.
结核性腹膜炎是肺外结核相对少见的一种表现形式。由于其临床表现不具特异性，如腹痛、发热或腹水，结核性腹膜炎的早期诊断较为困难。尤其是在腹部或盆腔手术后早期，这些症状可能会被误诊为化脓性腹膜炎。关于结核性腹膜炎作为腹腔镜手术术后并发症的报道较少。在此，我们描述了首例机器人辅助腹腔镜前列腺切除术（RALP）并扩大淋巴结清扫术后发生结核性腹膜炎的病例。一名78岁男性在该手术后25天出现发热和腹胀。超声检查和计算机断层扫描（CT）显示大量腹腔积液。腹水样本浑浊，白细胞增多，肌酐水平正常。未发现吻合口漏。考虑为淋巴管囊肿的细菌感染，给予头孢美唑2g/天，连用3天。尽管进行了抗菌治疗，发热仍持续。腹水的聚合酶链反应检测结果为阳性。该患者接受抗结核治疗后病情得到有效控制。这是首例关于RALP并扩大淋巴结清扫术后结核性腹膜炎作为术后并发症的报道。他术前的胸部CT显示左上肺有颗粒状阴影，提示既往有无症状结核感染。即使是在微创的机器人辅助腹腔镜手术后，结核也可能复发。尤其是当出现对抗生素无反应的不明原因腹水时，必须考虑结核性腹膜炎。
