SHM Converge Scientific Abstract ePoster Gallery-Dry Adhesive Type Peritoneal Tuberculosis

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This case describes a rare presentation of tuberculosis in a 26-year-old woman who developed progressive weight loss, abdominal pain, nausea/vomiting, and severe constipation. She had no fever, cough, dyspnea, prior abdominal surgery, or major malignancy risk factors. CT imaging showed a closed-loop small bowel obstruction without a clear transition point, along with ascites, peritoneal thickening, and nodularity; chest CT revealed small bilateral upper-lobe nodules.<br /><br />Ascitic fluid was lymphocyte-predominant with a low SAAG and negative cytology. Infectious testing was notable for a positive QuantiFERON-TB, while HIV and fungal studies were negative. Initial AFB smear and cultures were unrevealing, highlighting the limited sensitivity of fluid-based testing in peritoneal tuberculosis.<br /><br />Definitive diagnosis required peritoneal biopsy, which showed granulomatous inflammation with acid-fast bacilli, confirming dry adhesive tuberculous peritonitis. This form of extrapulmonary TB is uncommon and is characterized by peritoneal thickening/nodularity, minimal to moderate ascites, adhesions, and sometimes bowel obstruction, unlike the more common wet-ascitic type.<br /><br />The patient improved after treatment with RIPE therapy, with resolution of the obstruction and return of bowel function. The report emphasizes that clinicians should maintain suspicion for peritoneal TB in patients with unexplained abdominal obstruction and ascites, especially when ascitic studies are negative, because tissue biopsy may be necessary for diagnosis and timely treatment.

Asset Subtitle

Ryan Farquharson

Meta Tag

Author List Camille Hawkins, Ryan Farquharson

Category Clinical Vignettes

Concept Dry Adhesive Tuberculous Peritonitis

Concept Small Bowel Obstruction

Concept Closed-loop Bowel Obstruction

Concept Tissue Biopsy

Concept Peritoneal Thickening

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Alix School of Medicine

Presenting Author Ryan Farquharson

Track Adult

Keywords

tuberculosis

peritoneal tuberculosis

small bowel obstruction

ascites

peritoneal thickening

granulomatous inflammation

acid-fast bacilli

QuantiFERON-TB

extrapulmonary TB

RIPE therapy

Dry Adhesive Tuberculous Peritonitis

Small Bowel Obstruction

Closed-loop Bowel Obstruction

Tissue Biopsy

Peritoneal Thickening