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.