Surprising Presentation of Intra-abdominal Tuberculosis: A Case Report

Tuberculosis (TB) is a chronic infectious disease caused by <i>Mycobacterium tuberculosis</i>, posing a significant global health challenge, especially in low- and middle-income countries. While it primarily affects the lungs, it can also involve other organs, leading to varied clinical manifestations. We present the case of a 49-year-old male who experienced moderate right upper quadrant pain, nausea, and tenderness for one month. Initially diagnosed with acute cholecystitis based on clinical evaluation and imaging, intraoperative findings revealed disseminated peritoneal nodules and ascitic fluid, raising suspicion of abdominal TB. A retrograde cholecystectomy and right hemicolectomy were performed, but both acid-fast bacilli (AFB) staining and polymerase chain reaction (PCR) tests returned negative results. However, histopathological examination of the gallbladder ultimately confirmed TB, prompting the initiation of treatment. This case highlights the diagnostic challenges of abdominal TB, where clinical, radiological, and molecular tests may fail to provide conclusive results. Histopathology plays a critical role in diagnosis, and effective management often requires a combination of surgical intervention and prolonged anti-TB therapy. Early recognition of abdominal TB, particularly in atypical presentations, along with a multidisciplinary approach that includes both surgical and medical management, is vital for achieving successful outcomes. Prioritizing histopathological examination is essential when other diagnostic tests yield inconclusive results.