DOI: http://dx.doi.org/10.18203/2349-2902.isj20190469

The role of surgery in management of tuberculous peritonitis

Mohammed Hillu Surriah, Amine Mohammed Bakkour, Nidaa Ali Abdul Hussain

Abstract


Background: Tuberculous peritonitis is a serious condition with rising prevalence in recent years. The most common site of involvement is the ileo-caecal region. Treatment with standard antituberculous drugs is usually highly. Surgery is usually reserved for patients who have developed complications, obstruction or not responding to medical management. The aim of this study was to describe the surgical management of tuberculous peritonitis.

Methods: This study was carried out at Al-Karama Teaching Hospital between December 2015 to June 2018. A sixty patients with proved tuberculous peritonitis. It was a prospective study in which the records of the patients operated upon as peritonitis or acute intestinal obstruction and whose diagnosis was later confirmed as tuberculosis on histopathology were analysed with regards clinic-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality.

Results: Their age range was between 20-39 years, 25 (62.5%) were females and 15 (37.5) were males, abdominal distension and pallor were a common clinical finding 92.5% and 90% prospectively and 42.5 % of the patients have their complaints for 2-3 months, while history of pulmonary tuberculosis was present in 22.5% of the patients only. In 50% of the patients there were no important findings on chest X-ray. Ascites was positive in 82.5% of patients on abdominal sonography while on diagnostic laparoscopy in 45% of patients the findings were ascites with peritoneal and bowel adhesions.

Conclusions: Early diagnosis is the key factor in avoiding systemic and local complications of intestinal tuberculosis. Laparoscopy is the minimal invasive technique for definitive diagnosis with minimal sides effects.


Keywords


Ascitis, Ileocaecal region, Laparoscopy, Peritoneal tuberculosis

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References


Raviglione MC. Tuberculosis. Kasper DL, Hauser SL, Jameson JL, Fauci AS, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 19th ed. McGraw-Hill; 2015: 1102.

Vij JC, Malhotra V, Choudhary V, Jain NK, Prasad G, Choudhary A. A clinicopathological study of abdominal tuberculosis. Ind J Tuberculosis. 1992;39:213-20.

Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993;88(7):989-99.

Aston NO. Abdominal tuberculosis. World J Surg. 1997;21(5):492-9.

Bali RS, Jain R, Zahoor Y, Mittal A. Abdominal tuberculosis: a surgical emergency. International Journal of Research in Medical Sciences. 2017;5(9):3847-50.

Sharp JF, Goldman M. Abdominal tuberculosis in East Birmingham-a 16-year study. Postgraduate Med J. 1987;63(741):539-42.

Prakash A. Ulcero-constrictive tuberculosis of the bowel. Inter Surg. 1978;63(5):23.

Anstee QM, Jones DEJ. Tuberculosis. Ralston SH, Penman ID, Strachan MWJ, Hobson RP, eds. Davidson’s Principle and Practice of Medicine. 23rd ed. Elsevier; 2018: 812-813.

Baloch NA, Baloch MA, Baloch FA. A study of 86 cases of abdominal tuberculosis. J Surg Pak (Inter). 2008;13(1):30-2.

Sharma MP, Bhatia V. Abdominal tuberculosis. Ind J Med Res. 2004;120:305-15.

Mohammed A. Clinical profile and surgical outcome of abdominal tuberculosis-a retrospective analysis. Int J Med Health Sci. 2013;2:402-6.

Gondal KM, Khan AF. Changing pattern of abdominal tuberculosis. Pak J Surg. 1995;11(2):109-12.

Farmer P. Social inequalities and emerging infectious diseases. Emerg Inf Dis. 1996;2(4):259.

Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993;88(7):989-99.

Manohar A, Simjee AE, Haffejee AA, Pettengell KE. Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five-year period. Gut. 1990;31(10):1130-2.

Nafeh MA, Medhat A, Abdul-Hameed AG, Ahmad YA, Rashwan NM, Strickland GT. Tuberculous peritonitis in Egypt: the value of laparoscopy in diagnosis. Am J Tropical Med Hygiene. 1992;47(4):470-7.

Al-Quorain AA, Satti MB, Al-Freihi HM, Al-Gindan YM, Al-Awad N. Abdominal tuberculosis in Saudi Arabia: a clinicopathological study of 65 cases. Am J Gastroenterol. 1993;88(1):75-9.

Jakubowski A, Elwood RK, Enarson DA. Clinical features of abdominal tuberculosis. J Inf Dis. 1988;158(4):687-92.

Dülger AC, Karadaş S, Mete R, Türkdoğan MK, Demirkıran D, Gültepe B. Analysis of cases with tuberculous peritonitis: a single-center experience. Turk J Gastroenterol. 2014;25(1):72-8.

Ramaiya LI, Walter DF. Sonographic features of tuberculous peritonitis. Abdominal imaging. 1993;18(1):23-6.

Jorge AD. Peritoneal tuberculosis. Endoscopy. 1984;16(01):10-2.

Lope RC, Joglar SMG, Romero PF. Laparoscopic diagnosis of tuberculous ascites. Endoscopy. 1982;14(5):178-9.