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Exploratory laparotomy for diagnosis of tuberculous peritonitis
G E Lisehora1, Y T Lee, P J Barcia
1Department of Surgery, Tripler Army Medical Center, Honolulu.
Abstract:
Tuberculous (TB) peritonitis is uncommon but may present at any age and socioeconomic group. We reviewed 14 patients with TB peritonitis diagnosed during a five year period (six were white and eight, Pacific Islanders). The mean age was 31 years (a range of three to 69 years). Symptoms, signs and laboratory and roentgenologic studies were not specific. Peritoneal tap and laparoscopic procedures gave positive results of Mycobacterium tuberculi in four of seven patients. Diagnosis was not suspected in two patients until autopsy. TB peritonitis was confirmed at exploratory laparotomy in the other eight patients. Several common misconceptions about TB peritonitis have been discussed and refuted.
Insights
Tuberculous peritonitis is a rare condition affecting diverse populations. Diagnosis can be challenging due to non-specific symptoms, often requiring invasive procedures or autopsy for confirmation.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Tuberculous peritonitis (TB peritonitis) is an uncommon manifestation of tuberculosis.
- It can affect individuals across all age groups and socioeconomic backgrounds.
- Early diagnosis remains a clinical challenge due to non-specific clinical presentations.
Observation:
- A review of 14 patients diagnosed with TB peritonitis over five years was conducted.
- Patient demographics included varied ages (3-69 years) and ethnicities (White and Pacific Islanders).
- Clinical symptoms, physical examination findings, and initial diagnostic tests lacked specificity.
Findings:
- Mycobacterium tuberculosis was identified in 4 of 7 patients undergoing peritoneal tap or laparoscopy.
- Diagnosis was delayed, with two cases identified only during autopsy.
- Exploratory laparotomy confirmed TB peritonitis in the remaining eight patients.
Implications:
- The study highlights diagnostic difficulties associated with TB peritonitis.
- It underscores the importance of considering TB peritonitis in patients with unexplained ascites.
- Refuting common misconceptions may improve clinical suspicion and timely diagnosis of this rare condition.