Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey

Abstract

Abdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long-lasting and non-specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty-two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 +/- 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette-Guerin (BCG) scars and results of 5-tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non-specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality.

Assessment of 35 children with abdominal tuberculosis

“…One complaint at the time of presentation in abdominal tuberculosis is acute abdomen. The frequency of this varies between 7.7-15% (25,31,37,15). The frequency among our patients was 17.1%.…”

Tubercular bowel perforation: what to do?

“…Although the entire gut can be involved, the ileocecal area is most commonly affected. [1][2][3] Abdominal tuberculosis (TB) is the sixth most frequent extra-pulmonary location [3,4] and it is relatively rare in the industrialized world. On the other hand, the incidence of abdominal TB is increasing in western and developed countries due to immigration from developing countries, aging populations, increasing incidence of human immunodeficiency virus (HIV) infection, and misdiagnosis with ineffectual treatment.…”

Ascite: estado da arte baseado em evidências

“…Um volume adequado, em torno de 10 ml, deve ser inoculado em frascos de hemocultura que se mostram mais sensíveis que os frascos de cultura tradicionais 11 . Os frascos de hemocultura aumentam a positividade da cultura em ascites, com contagem de PMN ≥ 250 células/ mm 3 , de cerca de 50% (pelas técnicas convencionais) para 80% 19 . O volume a ser inoculado também é crítico.…”

“…O volume a ser inoculado também é crítico. A inoculação de 10 ou 20 ml em frascos de hemocultura de 100 ml produz taxas de positividade de 93%, enquanto o inóculo de 1 ml tem positividade de 53% 19 . Proteína: pacientes com nível de proteína na ascite < 1 gr/ dl tem alto risco de desenvolver PBE 20 .…”

“…Peritonite bacteriana espontânea O tratamento antibiótico na PBE deve ser considerado em pacientes com contagem de PMN ≥ 250/mm 3 no líquido ascí-tico 19,70 (Evidência grau A). Para o tratamento da PBE ou da ascite neutrocítica, recomenda-se o uso de Cefotaxima EV na dose de 2 gr de 8/8 horas por cinco dias 5 .…”