Laparoscopic Appearance of Peritoneal Tuberculosis

A 37-year-old Indian male with history of daily alcohol use presented to the hospital with abdominal pain and distention for 2 weeks. Abdominal and pelvic computed tomography showed ascites, peritoneal thickening with omental infiltration. Chest xray was normal, and sputum analysis was negative for infection. Ascitic fluid analysis showed a serum ascites albumin gradient of 0.8 g/dL, total protein level of 5.4 g/dL, and lymphocyte predominant cells. Blood cultures were negative. The patient also had an elevated CA 125, but work up for malignancy was negative. Finally, a laparoscopy was performed, which revealed multiple small homogeneous whitish nodules scattered all over the peritoneum and omentum (Figure 1). A biopsy was obtained, which showed necrotizing granulomas (Figure 2). The diagnosis of peritoneal tuberculosis (PTB) was confirmed. The patient was placed on antituberculosis therapy and discharged with close out patient follow-up.