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[Tuberculous peritonitis. 'Forgotten' disease]
D V Plotkin1, M V Sinitsyn2, M N Reshetnikov2
1Moscow Research and Clinical Center for TB Control of Moscow Healthcare Department, Hospital #2, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia.
Khirurgiia
|December 19, 2018
Summary
Tuberculous peritonitis diagnosis is improved with computed tomography and diagnostic laparoscopy. Combining imaging with peritoneal biopsy and molecular analysis aids accurate diagnosis in high-risk patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Radiology
Background:
- Tuberculous peritonitis presents with nonspecific symptoms, often complicating pulmonary tuberculosis and HIV-infection.
- Accurate diagnosis is challenging due to overlapping clinical presentations with other peritoneal diseases.
Purpose of the Study:
- To analyze the diagnosis and treatment of tuberculous peritonitis.
- To develop algorithms for instrumental examination and differential diagnosis.
Main Methods:
- Study included 48 patients with tuberculous peritonitis.
- Diagnostic tools: radiography, CT, ultrasound, laparoscopy, histological, cytological, microbiological, and molecular-genetic analysis of peritoneal samples.
- Exclusion criterion: signs of secondary peritonitis.
Main Results:
- Clinical presentation was nonspecific; 93.8% had prior pulmonary tuberculosis, 70.8% had HIV-infection.
- Diagnostic laparoscopy combined with cytological, molecular-genetic, and microbiological analysis achieved 87.2-95.8% diagnostic accuracy.
- Computed tomography was the most informative imaging method.
Conclusions:
- Tuberculous peritonitis should be suspected in patients with a history of tuberculosis or HIV-infection.
- Computed tomography is highly informative for diagnosis.
- Diagnostic laparoscopy with biopsy and comprehensive laboratory analysis is crucial for definitive diagnosis.