[A case of local reactivation of tuberculous peritonitis with suspected gastric submucosal tumors after laparotomy].

After complaining of right hypochondrial pain, a 36-year old man was diagnosed as having a gastric submucosal tumor at a nearby hospital and admitted to Chiba Cancer Center Hospital. On admission, a hard and immobile mass was palpable on the right upper quadrant. Laboratory findings were within normal limits. A chest X-ray revealed bilateral pleural adhesions and streaking shadows in the bilateral lung area. These findings were assumed to be due to a prior tuberculous infection. Upper gastrointestinal series and endoscopic examination showed a protruding lesion on the stomach body. An abdominal CT showed another lesion adjacent to the stomach antrum. A resection was carried out under the presumptive diagnosis of multiple gastric submucosal tumors. Exploration of the abdomen revealed widespread fibrous adhesion suspected to be due to prior old tuberculous peritonitis. Two tumors were located here. One was adjacent to the stomach body, and the other was adjacent to the liver and abdominal wall. Pathologically, both were caseated necrotizing granulomas composed of mature epithelioid cells and Langhans giant cells. A close examination revealed that one originated from the serosa of the stomach and the other from the peritoneum. Both were believed to be relatively new lesions. Pus obtained from the tumors tested positive for acid-fast bacilli. A post-operative tuberculin skin test was given and checked highly positive. From these findings, this case was diagnosed as local reactivation of old tuberculous peritonitis. After antituberculous chemotherapy at our hospital, the patient was discharged and sent home without any symptoms. The reason for the local reactivation was unknown.