A case of with massive ascites diagnosed with tuberculousperitonitis by laparoscopy in a 12-year-old girl

A 12-year-old girl had complained of abdominal pain for 1 month. She visited a local clinic because of fever over 38°C. The fever continued despite administration of antibiotics, and she was referred to the Department of Pediatrics at our hospital, which in turn referred her to the Department of Gynecology because she had massive ascites. No abnormal findings were detected in the uterus or ovaries by ultrasonography. Enhanced computed tomography revealed massive ascites, peritoneal thickening, many small nodules in the omentum, and bilateral pleural effusion. Serum CA125 level was remarkably elevated (1,538 U/ml). In addition, adenosine deaminase levels in ascetic fluid were elevated (136 U/l). Cytological examination of the ascites showed many neutrophils but no malignant cells. Laparoscopic examination was performed for diagnosis, which revealed diffused miliary white modules in the whole abdomen. Peritoneal biopsy was performed, and pathological examination showed formation of epithelioid granuloma with partial necrosis. The clinical diagnosis was tuberculous peritonitis.