Article

Case report

Peritoneal tuberculosis: a benign differential

diagnosis of ovarian cancer with peritoneal
carcinomatosis (a case report)

Anas Ahallat, Mohamed Al Amine El Mouden, Younes Aggouri, Said Ait Laalim

Corresponding author: Anas Ahallat, Department of General Surgery, University Hospital Center, Tangier, Morocco.
[email protected]

Received: 07 May 2023 - Accepted: 09 Jul 2023 - Published: 07 Aug 2023

Keywords: Peritoneal tuberculosis, ovarian cancer, laparoscopy, case report

Copyright: Anas Ahallat et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed
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Cite this article: Anas Ahallat et al. Peritoneal tuberculosis: a benign differential diagnosis of ovarian cancer with
peritoneal carcinomatosis (a case report). Pan African Medical Journal. 2023;45(151).
10.11604/pamj.2023.45.151.40327

Available online at: https://www.panafrican-med-journal.com//content/article/45/151/full

Peritoneal tuberculosis: a benign differential Abstract

diagnosis of ovarian cancer with peritoneal
carcinomatosis (a case report) Peritoneal tuberculosis is a rare form of tuberculosis
which gives a non-specific clinical picture which can
Anas Ahallat1,&, Mohamed Al Amine El Mouden1, be confused with several digestive pathologies. It
Younes Aggouri1, Said Ait Laalim1 can also mimic ovarian cancer at the stage of
1 peritoneal carcinomatosis, hence the interest
Department of General Surgery, University
sometimes of a diagnostic laparoscopy which
Hospital Center, Tangier, Morocco
makes it possible to make the diagnosis which is
& confirmed by an anatomo-pathological study. This
Corresponding author
is the case of our patient who was initially
Anas Ahallat, Department of General Surgery,
diagnosed with ovarian cancer and the diagnosis
University Hospital Center, Tangier, Morocco
 Article
was corrected in peritoneal tuberculosis after a Patient and observation
laparoscopy.
Patient information: a 27-year-old woman, G1P1
Introduction (G=gravidity=1, P=parity=1) referred to the
emergency department for abdominal pain
Tuberculosis is a disease caused by a localized at the hypogastric level, with
mycobacterium of the tuberculosis complex hemodynamic stability, without any notion of
characterized by its contagiousness, and still contracture or abdominal defense, with a reported
represents a public health problem in developing notion of fever which couldn´t be found on the
countries. Indeed, in Morocco, in 2019, the number general examination.
of cases estimated by the WHO was 35,000 new
cases and the estimated number of deaths related Timeline: 1 week.
to tuberculosis was 2,900 deaths, which
means a specific mortality rate of 8.1 per 100,000 Clinical findings: however, on clinical examination,
residents [1]. the presence of abdominal ascites was noted,
which prompted to realize an abdominal
In 2020, the number of cases recorded was 29,018 ultrasound that confirmed the presence of
cases, all forms combined, with two hundred and abdominal ascites of moderate abundance, in
forty cases coinfected with tuberculosis and human addition to an ovarian mass measured at 56x48mm.
immunodeficiency virus (HIV) [2]. Of which one of
the most particular forms of extra-pulmonary Diagnostic assessment: biologically the patient
manifestation is peritoneal tuberculosis which presented an increased CA 125 to 198 u/ml with a
affects the intestine, liver, spleen, female level of normal white blood cells at 6000 and
genital tract, omentum, parietal and visceral hemoglobin at 10.4 g/dl. An additional CT scan was
peritoneum which accounts 1-2% of all forms of in favor of a possible malignant ovarian mass with
tuberculosis [3]. Taking into account that this type peritoneal carcinomatosis, with normal chest
of peritoneal manifestation of tuberculosis disease images.
is rare, and with a non-specific clinical presentation
essentially abdominal distension, ascites, Therapeutic intervention: subsequently, the
tenderness, fever and weight loss, this explains the patient underwent a mini-laparotomy, finding no
diagnostic delay which is around 4 months, ovarian mass but an increase in the volume of the
however in the female population, the presence of ovarian tubes as well as several peritoneal and
ascites, adnexal mass and elevated CA125 may small bowel deposits (Figure 1) and
suggest ovarian cancer, but the diagnosis of mesenteric lymphadenopathy (Figure 2). The
peritoneal tuberculosis which is a benign pathology anatomopathological examination of the various
occurs at a young age between the ages of 20 and epiploic peritoneal samples and nodules was in
40 should not be omitted [4], while ovarian cancer favor of peritoneal tuberculosis, without the
occurs in an older population. The present work has presence of cells suspected of malignancy.
set itself the objective of reporting the case of a 27-
Follow-up and outcomes: the patient was
year-old woman with several tuberculous
subsequently put on anti-tuberculosis treatment
peritoneal and grelic nodules initially misdiagnosed
with good clinical improvement.
as ovarian cancer at the stage of peritoneal
carcinomatosis. Patient perspective: the patient was satisfied with
the treatment and happy to preserve her ovary.

Anas Ahallat et al. PAMJ - 45(151). 07 Aug 2023. - Page numbers not for citation purposes. 2
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Informed consent: the patient gave informed Conclusion
consent.
In endemic areas, peritoneal tuberculosis should
Discussion always be considered as a differential diagnosis
while encountering a case of a young woman
It is not always easy to distinguish between presenting abdominal pain with pelvic mass and
peritoneal tuberculosis and ovarian cancer at the ascites even with elevated rate of CA 125, because
stage of peritoneal carcinomatosis even based on peritoneal tuberculosis can mimic malignancy and
the CA 125 rate, which can lead to abusive cause a delay in diagnosis. Also, when noninvasive
laparotomies in young patients, however, most procedures do not lead to diagnosis, invasive
cases can be diagnosed using a laparoscopy which methods should be considered to distinguish
seems to be the best alternative [5], especially between the two pathologies.
when we know that the tumor marker, laboratory
investigations and radiological imaging are also Competing interests
non-specific [6] because CA-125 is a glycoprotein,
which is expressed by cells lining the uterine The authors declare no competing interests.
endometrium and serum levels are elevated in
conditions such as ovarian malignancy,
endometriosis and pelvic inflammatory
Authors' contributions
disease [7]. CA-125 is also expressed by cells lining
All authors read and approved the final version of
the pleura, pericardium, and peritoneum and
the manuscript.
therefore serum levels may be elevated in
tuberculous peritonitis, intestinal malignancies,
and in postoperative cases [7]. Figures
In our case, the clinical presentation could hardly Figure 1: granulations of visceral peritoneum of the
suggest peritoneal tuberculosis, apart from the fact small intestine
that the age of the patient is in favor of tuberculosis Figure 2: mesenteric lymphadenopathy
and the epidemiological context of Morocco, since
it is a region of the world where tuberculosis is still References
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Figure 1: granulations of visceral peritoneum of the small
intestine

Figure 2: mesenteric lymphadenopathy

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