Case report: diagnostic approach to malignancy ascites patient who misdiagnosed with abdominal tuberculosis

Abstract

Introduction: Ascites is an accumulation of free fluid with an abnormal amount in the peritoneal cavity. The causes of ascites are hepatic cirrhosis, malignant ascites, and mixed ascites, which can be caused by tuberculosis infection. Malignant ascites is a pathological condition caused by primary abdominal and extra-abdominal malignancies. This study aims to report malignant ascites that was misdiagnosed with abdominal tuberculosis. Case Presentation: Forty-one years old man came with an enlarged stomach, pain in the abdomen, fever, and decreased appetite accompanied by >20 kg weight loss with a change in bowel habits in the last 3 months. At first, the patient was diagnosed with abdominal tuberculosis and took a tuberculosis drug regimen for almost 2 months. However, the patient did not feel any improvement in the symptoms he was experiencing. The patient then went to Soetomo General Hospital and underwent several examinations. In colonoscopy examination, we found a mass in the transverse colon that almost covered the lumen with hard consistency and was not easy to bleed. Pushing outside the recto-sigmoid lumen causes narrowing of the lumen, and from CT scan showed a solid mass in the pelvic cavity; visible lesions penetrate the serosa to form a picture of "fat stranding," attached to the rectum posteriorly and bluntly to the anterior; multiple nodules in the left mesentery with peritumoral lymphadenopathy can be a feature of malignant soft tissue mass. Ascites accompanied by multiple nodular peritoneal thickening and thickening of the omentum that forms an omental cake can represent peritoneal carcinomatosis. The results of the open biopsy obtained histopathological results in the adverse colon suggesting adenocarcinoma, signet ring cell carcinoma. All the examination results led to the diagnosis of colorectal cancer. Conclusion: A 41 years old man, who was misdiagnosed with abdominal tuberculosis and had been taking the drug for tuberculosis for 2 months, has no improvement in his symptoms. Then he went to Soetomo General Hospital and underwent several examinations, which led to the diagnosis of colorectal cancer. This instance demonstrates that some doctors still struggle to diagnose colorectal cancer, even if patient outcomes improve with earlier treatment.