Tuberculous peritonitis--reports of 26 cases, detailing diagnostic and therapeutic problems.

Abstract

OBJECTIVE:

To evaluate the clinical presentation, biochemical (ascites and serum) and laparoscopic findings, and to assess the efficacy of triple antituberculous therapy without rifampicin for 6 months in patients with tuberculous peritonitis.

METHODS:

Twenty-six tuberculous peritonitis patients (11 male, 15 female) with a mean age of 34.8 +/- 3.4 years (range 14-77) were assessed with regard to diagnostic and therapeutic features.

RESULTS:

The most common symptoms and signs were abdominal pain (92.3%) and ascites (96.2%), respectively. Tuberculin skin test (TST) was positive in all patients. An abnormal chest radiography suggestive of previous tuberculosis was present in five patients (19.2%), and two patients (7.7%) had extra-peritoneal (cerebral, pericardial) active tuberculous involvement. In 24 of the 25 patients who underwent laparoscopy with directed biopsy, whitish nodules suggested tuberculous peritonitis; 76% of the biopsy specimens revealed caseating, 20% non-caseating granulomatous inflammation, and 4% non-specific findings. The ascitic fluid of one patient (3.8%) was positive for acid-resistant bacilli, and culture was positive in two patients (7.7%). Twenty-four of the patients were treated for 6 months with isoniazid, streptomycin (total dose 40 g) and pyrazinamide (for the first 2 months and then substituted with ethambutol). Eighteen patients also received methyl prednisolone, initially 20 mg/day, for 1 month. The follow-up period was 19 +/- 1.7 months after the end of therapy (range 6-36). Ascites and abdominal pain abated earlier in patients on steroid therapy. All but two of the 24 patients responded to treatment.

CONCLUSION:

Non-invasive tests such as acid-fast stain and culture of the ascitic fluid are usually insufficient, hence invasive laparoscopy and peritoneal biopsy are necessary for the diagnosis of tuberculous peritonitis if non-invasive tests such as ascites adenosine deaminase activity measurement are not easily available. Triple therapy without rifampicin for 6 months is sufficient to treat tuberculous peritonitis.

• Authors: K Demir, A Okten, S Kaymakoglu, D Dincer, F Besisik, U Cevikbas, S Ozdil, G Bostas, Z Mungan, Y Cakaloglu
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 13 Issue 5 Pg. 581-5 (May 2001) ISSN: 0954-691X [Print] England
• PMID: 11396540 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents
• Biopsy
• Diagnosis, Differential
• Drug Therapy, Combination (therapeutic use)
• Female
• Humans
• Laparoscopy
• Male
• Middle Aged
• Peritoneum (pathology)
• Peritonitis, Tuberculous (diagnosis, drug therapy, pathology)
• Treatment Outcome
• Tuberculin Test