Tuberculous enteritis and peritonitis

In Turkey, diseases associated with Mycobacterium tuberculosis are common. Intestinal tuberculosis has generally been a complication of pulmonary tuberculosis, but recently there has been an increase in the frequency of intestinal tuberculosis without the pulmonary form. The authors present their experience over 8 years in 41 patients (aged 15 to 56 years) who underwent surgery for tuberculous enteritis (14), peritonitis (13), a combination of the two (5), genital tuberculosis and peritonitis (5) and tuberculous mesenteric lymphadenitis (4). Of these, 29 had no associated pulmonary tuberculosis. Eighteen of the 41 patients had complications of their disease-bowel obstruction in 13, intestinal perforation in 2, intestinal bleeding in 2 and enterocutaneous fistula in 1. The diagnosis was established at operation and by the appearance of caseating granuloma on histologic examination and isolation of the causative organism. Twenty-four patients required emergency surgery; 2 who had bowel perforation died. Operative procedures included laparotomy with biopsy (17), resection of intestine (10), division of adhesions (7), evacuation of mesenteric abscesses (4) and bypass (3). There were seven (17%) operative deaths. The authors recommend that noninvasive procedures be used for the diagnosis of intestinal tuberculosis, but if these fail, surgery is indicated.