Port Site Tuberculosis Masquerading as Surgical Site Infection following Laparoscopic Ovarian Cystectomy

Abstract

Port site infections (PSIs) are a recognized complication of laparoscopic surgery, typically attributed to bacterial pathogens. Tuberculosis (TB) presenting as PSI is exceedingly rare and poses a significant diagnostic challenge, particularly in endemic regions. This case highlights the importance of histopathological evaluation of seemingly routine surgical wound infections. A 29-year-old woman presented with persistent abdominal pain and purulent discharge from laparoscopic port sites following right ovarian cystectomy and oophorectomy performed for a confirmed dermoid cyst (mature cystic teratoma). Despite the initial management for presumed bacterial PSI, the wound did not heal. Imaging revealed fistulous tracts with intraperitoneal extension, a complex left adnexal lesion, omental nodularity, and diffuse peritoneal thickening – features raising concern for a neoplastic or granulomatous process. Surgical debridement was done and tissue samples were sent for histopathological examination. Multiple specimens from the omentum, peritoneum, and the right iliac fossa port site demonstrated necrotizing granulomatous inflammation with multinucleated giant cells. Acid-fast bacilli were not visualized on Ziehl–Neelsen staining. However, the constellation of histopathological findings was consistent with TB. The patient was started on standard four-drug anti-tubercular therapy and demonstrated a satisfactory clinical response with progressive wound healing and resolution of symptoms. Port site TB should be considered in the differential diagnosis of nonhealing laparoscopic port wounds in TB-endemic regions. Early histopathological assessment of debrided tissue is critical for timely diagnosis and appropriate treatment.