腹腔鏡検査が有用であった結核性腹膜炎の1例—腹腔鏡検査の重要性

A case of tuberculous peritonitis diagnosed by laparoscopic examination:Importance of laparoscopic examination

　発熱と腹水貯留の精査・加療を目的で入院となった64歳の女性．腹水の細胞診陰性，結核菌培養陰性，結核菌PCR陰性，リンパ球優位の細胞増多，adenosine deaminase（ADA）活性高値で結核性腹膜炎が疑われ，確定診断の目的で腹腔鏡検査を施行した．線維性癒着と粟粒大の結節性病変を認めた．病理組織学的所見ではラングハンス型巨細胞と肉芽腫を認め，結核性腹膜炎と診断された．結核性腹膜炎はまれで，本症例のように既往歴・随伴性病変のない場合の診断は困難である．原因不明の腹水を有する患者では腹腔鏡検査が重要であり，典型的な腹腔鏡所見を知っておくことが肝要である．

A 64-year-old woman was admitted to our hospital with fever and ascites. We suspected tuberculous perito-nitis, because of the following reasons. The cytology and culture of ascites was negative. PCR test against myco-bacterium tuberculosis was negative. Lymphocytes dominated the cell component of ascites. The ADA level of ascites was high. For accurate diagnosis, laparoscopic examination was performed. We were able to observe fi-brous adhesion and some tiny white nodules.