van Dongen Karlijn S M, Binnerts Joost J, Montauban van Swijndregt Alexander D, Jansen Rogier R, van den Berk Guido E L, Verhoeve Harold R
OLVG, Amsterdam.
Contact: Harold R. Verhoeve (
Ned Tijdschr Geneeskd. 2022 Nov 23;166:D6762.
The non-specific symptomatology in peritoneal tuberculosis often results in a delay in the diagnosis. Due to clinical overlap symptoms may be confused with metastatic ovarian carcinoma. This can lead to delayed treatment, unnecessary surgical interventions and a deteriorated prognosis.
A 75-year-old female of Moroccan descent was referred to the gastroenterology department with increasing ascites and weight loss. Based on the clinical picture metastatic ovarian cancer was suspected. However, repeatedly no malignant cells were found in both ascitic fluid and tissue biopsies. Peritoneal tuberculosis was considered and ovarian malignancy could not be excluded. A diagnostic laparoscopyand biopsy was considered necessary. The laparoscopic view was pathognomic for tuberculosis after which antituberculosis treatment was started with good result.
Peritoneal tuberculosis should be included in the differential diagnosis in women from endemic areas with symptoms of abdominal pain, ascites, weight loss and/or increased CA-125. Laparoscopy should be considered if less invasive tests are inconclusive about the diagnosis.
腹膜结核的非特异性症状常导致诊断延迟。由于临床症状重叠，可能会与转移性卵巢癌混淆。这可能导致治疗延迟、不必要的手术干预以及预后恶化。
一名75岁的摩洛哥裔女性因腹水增多和体重减轻被转诊至胃肠病科。根据临床表现，怀疑为转移性卵巢癌。然而，在腹水和组织活检中反复未发现恶性细胞。考虑为腹膜结核，但不能排除卵巢恶性肿瘤。认为有必要进行诊断性腹腔镜检查和活检。腹腔镜检查所见具有结核特征，随后开始抗结核治疗，效果良好。
对于来自流行地区、有腹痛、腹水、体重减轻和/或CA-125升高症状的女性，鉴别诊断应包括腹膜结核。如果侵入性较小的检查对诊断不明确，应考虑腹腔镜检查。
