3.Method (Differential diagnosis, investigation and treatment)
The differential diagnosis including, uterus rupture, hemoperitoine,
ruptured ectopic pregnancy, and ovarian cyst.
The patient subsequently underwent diagnostic laparotomy due to
suspicious unsafe abortion in the history, abdominal examination, and
severe anemia with the probable diagnosis of acute abdomen. Laparotomy
revealed 3 liters thick yellow pus in the abdominopelvic cavity, and
substantial adhesions between viscera, and several small-scale nodular
implants on the surface of the peritoneal, liver, and stomach. The
intestine, omentum, mesentery, uterine, ovaries, and fallopian tubes
were normal except for inflammation. Irrigation of the abdominopelvic
cavity and adhesiolysis were conducted. There was no specific site for
the purulent ascites in exploration. Tissue samples from the peritoneum,
omentum, and lymph nodes were sent to pathology and some tissue samples
and ascetic fluid were sent for the microbiology, cytology, and PCR for
tuberculosis examinations. The patient was treated with intravenous
broad-spectrum antibiotics for 72 hours. Tissue samples of the
pathological study showed granulomatous inflammation and samples for
smear and culture and cytology revealed negative findings. In addition,
COVID-19 PCR was reported to be negative.
According to a large amount of intraperitoneal pus without a specified
source and granulomatous inflammation on pathology report (figure 3, 4),
PPD test, and chest radiography were conducted with the probable
diagnosis of tuberculosis. PPD was negative but CXR revealed patchy
consolidations. The family history and past history of the patient’s TB
were negative. Meanwhile, there were no previous computed tomography
(CT) scans or CXR being conducted for this patient.