A Case Report of Atypical Presentation of Abdominal Tuberculosis with Concurrent Broad Ligament Cyst: Laparoscopy as a Diagnostic Tool

Background: Abdominal tuberculosis (TB) continues to be important health concern in India. The diagnosis is often challenging because of its non-specific presentation. Conventional laboratory and microbiological methods are usually time consuming and requires a high clinical index of suspicion. Laparoscopy with biopsy is an efficient tool for rapid and accurate diagnosis of abdominal tuberculosis. We aimed to demonstrate the effectiveness of laparoscopy in diagnosing a case of abdominal tuberculosis presented as ovarian cyst. Case presentation: A 22 year young female presented to our surgery outdoor clinic with history of abdominal pain lasting for 4 months. Her laboratory tests were unremarkable including a normal CA 125 with raised ESR. A CT scan was performed which revealed a cystic mass in left ovary. Considering the possibility of pelvic cyst and abdominal TB, a diagnostic laparoscopy was performed. At laparoscopy, adhesions or fibrinous networks between liver and peritonium, enlarged mesenteric lymph nodes and ascites were seen along with left broad ligament cyst with left atrophied ovarian tissue. She underwent left sided salplingo-oopherectomy with resection of cyst with biopsy from mesenteric nodes and peritoneal aspiration. The histopathological diagnosis from lymph nodes during the procedure confirmed as chronic granulomatous inflammation with casesous necrosis favouring tuberculosis. The peritoneal aspirate shows a raised ADA and positive CBNAAT for MTB further confirmed the diagnosis. She was started with standard antitubercular drugs. Postoperatively, she recovered uneventfully and responded well to the ATT therapy. Conclusion: In cases of chronic abdominal pain, a significant clinical suspicion is necessary keeping abdominal TB as an important differential diagnosis. Laparoscopy with biopsy is an effective tool for early diagnosis of abdominal tuberculosis.