A 39-year-old man with alcoholism for 20 years complained of fever, intermittent diffuse abdominal pain, and progressive abdominal distention for 2 weeks. Results of physical examination and abdominal sonography revealed ascites without jaundice. Results of acid-fast staining and polymerase chain reaction of the aspirated ascitic fluid, with numerous lymphocytes, were negative for any bacilli or Mycobacterium tuberculosis. Abdominal magnetic resonance imaging showed septate fluid-containing cavities and thickened peritoneum (Figure 1). Laparotomy revealed violin string–like fibrinous strands, white miliary nodules, and omental thickening (Figure 2).
Abdominal magnetic resonance image shows lobulated ascites and thickened peritoneum.
Laparotomy reveals violin string–like fibrinous strands, white military nodules, and omental thickening.
A. Carcinomatosis peritonei
C. Tuberculous peritonitis
D. Starch peritonitis
Ho C, Lee P. Image of the Month—Quiz Case. Arch Surg. 2007;142(12):1219. doi:10.1001/archsurg.142.12.1219