A case of intestinal fistula following surgery for a large ovarian tumor complicated by abdominal tuberculosis: a case report and review of the literature.

BACKGROUND: Abdominal tuberculosis is a rare and diagnostically challenging form of extrapulmonary tuberculosis that can closely mimic advanced ovarian cancer both clinically and radiologically. This case is reported to highlight this diagnostic dilemma and the serious postoperative complications that can arise, to enhance clinical awareness and reduce misdiagnosis. CASE PRESENTATION: A 68-year-old female of Asian ethnicity presented with a 1-year history of heartburn and significant weight loss. Preoperative evaluation revealed a large pelvic mass, elevated cancer antigen-125 (309.2 U/mL), and ascites, highly indicative of ovarian malignancy. She underwent laparoscopic exploration converted to laparotomy for left adnexectomy owing to extensive adhesions. Postoperative pathology confirmed a benign ovarian mucinous cystic adenoma and, unexpectedly, necrotic granulomatous tissue was observed in the abdominal wall tissue and mesosalpinx, consistent with tuberculosis. A total of 2 weeks post surgery, the patient developed an enterocutaneous fistula, which was managed conservatively with targeted antituberculosis therapy, prolonged drainage, and nutritional support. After over a year of treatment, the fistula healed completely and the patient regained weight, achieving a full recovery. CONCLUSION: This case underscores the importance of considering abdominal tuberculosis in the differential diagnosis of ovarian cancer, especially in endemic areas. A high index of suspicion, utilizing a combination of diagnostic tools, and careful intraoperative assessment are crucial. Once diagnosed, conservative management with sustained antituberculosis therapy and nutritional support can lead to excellent outcomes even for complex complications such as intestinal fistula, avoiding the need for high-risk reoperation.