Woodly Dominique, DO, Viktoria Rutherford, DO, Sara Alleyasin, DO, Brian Carlson, MD Valley Health System, Las Vegas, NV Introduction: Differentiating between peritoneal TB and carcinomatosis remains challenging due to overlapping presentations. This diagnostic dilemma affects clinical management, particularly in patients with rapid clinical deterioration. Features including young age, exudative ascites, normal tumor markers, and characteristic "frozen abdomen" appearance can occur in both conditions, necessitating careful evaluation.
Case Description/
Methods: A 36-year-old male with peptic ulcer disease presented with abdominal pain and 80-pound weight loss over two months. CT showed peritoneal disease with complex ascites. Tumor markers were normal. Upper endoscopy revealed a 4cm gastric antral lesion, but initial biopsies showed only hyperplastic changes. Paracentesis yielded exudative ascites with negative cytology. The patient deteriorated within two weeks, developing bowel perforation. Laparoscopy revealed a "frozen abdomen" with dense adhesions. QuantiFERON-TB Gold returned indeterminate. The patient developed septic shock requiring ICU care. Re-examination of initial biopsies eventually confirmed gastric adenocarcinoma. Discussion: This case illustrates key diagnostic challenges: (1) Normal tumor markers don't exclude peritoneal carcinomatosis; (2) Initial negative biopsies occur in both TB and malignancy; (3) The "frozen abdomen" appearance isn't specific to either condition; (4) Delayed diagnosis can lead to devastating outcomes. Research shows peritoneal TB typically affects younger patients (mean 39.2 years vs. 60 years in carcinomatosis) and presents with more frequent abdominal masses (40.0% vs. 10.5%), while abdominal distension is more common in carcinomatosis (78.9% vs. 53.3%).
Figure: Figure 1: Complex ascites with the presence of loculation & Fat Stranding in the omentum tissue changes, suggesting Tuberculous peritonitis: fibrotic fixed type
Figure: Figure 2: Thickened mesentery on CT
Disclosures: Woodly Dominique indicated no relevant financial relationships. Viktoria Rutherford indicated no relevant financial relationships. Sara Alleyasin indicated no relevant financial relationships. Brian Carlson indicated no relevant financial relationships.
Woodly Dominique, DO, Viktoria Rutherford, DO, Sara Alleyasin, DO, Brian Carlson, MD. P4740 - Gastric Adenocarcinoma Presenting With Features Mimicking Abdominal Tuberculosis: A Diagnostic Challenge, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
