81-year-old previously healthy man presented with epigastric pain, dyspeptic symptoms, vomiting, loss of appetite and weight loss for six weeks duration. There is no contact history of TB. The examination revealed a doughy mass in the epigastric region and all other systems including general examination to be normal. He was investigated in Teaching hospital professorial surgical unit, Jaffna.
Blood investigations, full blood count, renal function and liver function were within normal limits except erythrocyte sedimentation rate (ESR) was 88 mm / 1st hour.
His chest X ray was normal. Ultrasound scan of abdomen revealed suspicious omental mass in epigastric region. Enhancing mass lesion was reported in CECT abdomen of this patient which was located in the mesentery of left hypochondrium and appeared to be infiltrating anterior abdominal wall. The upper GI endoscopy revealed mild antral gastritis and colonoscopy was unremarkable (Fig. 1).
The USS guided core biopsy of the lesion done by radiologist and its revealed granulomatous inflammation of fibrofatty tissues with highest possibility of omental tuberculosis (Fig. 2).
Then he was referred to the Chest clinic and anti TB treatment was started (2 months HRZE then four months HR). The mass resolved completely at completion of six months of anti TB treatment.