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Objective: To assess the role of ultrasonography (US) and US-guided puncture in the diagnostic procedure of tuberculous peritonitis., Design: Retrospective study., Setting: An inner-city hospital: Westeinde Ziekenhuis, The Hague, the Netherlands., Methods: Of 12 patients with bacteriologically confirmed tuberculous peritonitis diagnosed between 1987 and 1995, the results of ultrasonography and the bacteriological and cytological results of US-guided puncture were studied., Results: The ultrasonographic appearance of wet tuberculous peritonitis was recognized by the radiologist in all 11 cases. There was loculated ascites with fine septations as well as thickening of peritoneum, mesentery and omentum. Ultrasonography was of no merit in the one case of peritonitis sicca in this study. US-guided puncture of ascites and omentum yielded a bacteriological diagnosis in eight patients, six of whom had a positive Ziehl-Neelsen or auramine test. In two other patients cytological examination showed a granulomatous inflammation. On average, the ultrasonographic diagnosis of wet tuberculous peritonitis was suggested 3 days after admission and bacteriologically confirmed 10 days later. Eleven of the 12 patients were immigrants from countries where tuberculosis is endemic. The mean duration of residency in the Netherlands was 7 years., Conclusion: Ultrasonography is valuable in the diagnostic procedure of tuberculous peritonitis in that it considerably reduces diagnostic delay and unnecessary surgical procedures are avoided.