An important diagnosis of ascites and abdominal mass coexistence in a child: Peritoneal tuberculosis

Abstract

Tuberculosis is still a life-threatening disease worldwide, particularly in developing countries. Miliary tuberculosis is an important diagnosis in children which needs urgent treatment. A 15-year-old male patient was investigated for an abdominal mass with the symptoms of chronic abdominal pain, weight loss, and ascites. On ultrasonography, a 4.5x4x4 cm sized mass that could not be differentiated whether cystic or solid was defined at left paraumbilical region. During laparotomy, widespread punctate granulomas were seen on the intestinal surfaces, peritoneum, and thickened omentum. Tissue biopsies were taken with preliminary diagnosis of possible tuberculosis. The pathological examination was compatible with granulomatous inflammation involving caseous necrosis. In conclusion, miliary tuberculosis with abdominal involvement is a rare type of the disease and can also be seen in pediatric patients without lung tuberculosis. Percutaneous sampling of ascites fluid may not be enough for the diagnosis. Tissue sampling is the most appropriate method for diagnosis and timely treatment for abdominal tuberculosis in children.