Peritoneal Tuberculosis

12/02/02 (Desai)

Question:  How is peritoneal tuberculosis diagnosed?

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Unique Identifier:10219360

Authors: Ahmad M. Ahmed A.

Institution: Department of Medicine, Baqai Hospital, Baqai Medical College, Karachi, Pakistan.

Title: Tuberculous peritonitis: fatality associated with delayed diagnosis. [Review] [11 refs]

Source: Southern Medical Association Journal. 92(4):406-8, 1999 Apr.

Abstract: We describe a fatal case of tuberculous peritonitis and review the literature on the diagnostic modalities available to diagnose this entity. We suspect a delayed diagnosis resulted in the death of our patient. Today, the prompt diagnosis of an unknown ascitic process involves laparoscopy. A patient with unknown large volume ascites is the easiest and safest to laparoscope. Using a mini laparoscope, a bedside procedure with instantaneous return can be done. The newer noninvasive tests like determination of ascites fluid adenosine deaminase activity and polymerase chain reaction may be helpful in the prompt diagnosis of peritoneal tuberculosis. We recommend that patients with clinical presentation suggestive of peritoneal tuberculosis have either an aggressive diagnostic workup using high-yield tests or a trial of antituberculous therapy. [References: 11] CAS Registry/EC Number 0 (Antibiotics).

  Link Directly to Fulltext Article at Science Direct

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Unique Identifier:8629652

Authors: Shakil AO. Korula J. Kanel GC. Murray NG. Reynolds TB.

Institution: Liver Unit, University of Southern California School of Medicine, Rancho Los Amigos Medical Center, Downey, USA.

Title: Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease: a case control study. [see comments.].

Source: American Journal of Medicine. 100(2):179-85, 1996 Feb.

Abstract: PURPOSE: To determine diagnostic features of tuberculous peritonitis (TBP) in the absence and presence of chronic liver disease. PATIENTS AND METHODS: Thirty-four patients with TBP (13 without [Group I] and 21 with chronic liver disease [Group II] and 26 controls with cirrhosis and uninfected ascites (Group III) were studied. RESULTS: The clinical features in Groups I and II were similar and all patients had elevated ascitic fluid total mononuclear cell count. In Groups I, II, and III, respectively, ascitic fluid protein was > 25 g/L in 100% (13/13), 70% (14/20), and 0% (0/26); serum-ascites albumin gradient (SAAG) was > 11 g/L in 0% (0/13), 52% (11/21), and 96% (25/26), (0% [0/13], 71% and 2 over black square]; [1 and 2 over black square]5/21], and 96% [25/26] after correction for serum globulin); and ascitic fluid lactate dehydrogenase (LDH) level was > 90 U/L in 100% (12/12), 84% (16/19), and 0% (0/20), respectively. In Groups I and II combined, ascitic fluid acid-fast stain was negative in all but Mycobacterium tuberculosis culture was positive in 45% (10/22); peritoneal nodules occurred in 94% (31/33), granulomas in 93% (28/30), and positive peritoneal M tuberculosis culture in 63% (10/16). CONCLUSIONS: In patients with suspected TBP, ascitic fluid protein of > 25 g/L, SAAG of < 11 g/L and LDH of > 90 U/L have high sensitivity for the disease. With coexistent chronic liver disease, a lower protein level and higher SAAG are usually not helpful but LDH > 90 U/L is a useful parameter for screening. Diagnosis is best confirmed by laparoscopy with peritoneal biopsy and M tuberculosis culture.

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Unique Identifier:2150661

Authors: Manohar A. Simjee AE. Haffejee AA. Pettengell KE.

Institution: Department of Medicine, (Gastrointestinal unit), University of Natal/King Edward VIII Hospital, Durban, South Africa.

Title: Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period. [see comments.].

Source: Gut. 31(10):1130-2, 1990 Oct.

Abstract: This study analysed clinical features and laboratory investigations in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy at this hospital between 1984 and 1988. Tuberculous peritonitis was found in 2% of all patients with tuberculosis and in 59.8% of all those with abdominal tuberculosis admitted to the hospital during the study period. Tuberculous peritonitis was more common in women than men (1.4:1) and was most frequently encountered in the third and fourth decades of life. The commonest presenting symptoms were abdominal swelling (73.1%), fever and night sweats (53.8%), anorexia (46.9%), weight loss (44.1%), and abdominal pain (35.9%). The mean duration of symptoms was 1.5 months. Ascites was the commonest (95.2%) physical sign. Tuberculin skin testing was positive in 57.6% of patients (n = 118). The mean erythrocyte sedimentation rate was 75 mm/1st hour (n = 58). Chest radiography on 98 patients showed pleuropulmonary pathology in 40 patients (40.8%). Sputum examination confirmed active pulmonary tuberculosis in 26 patients. The ascitic fluid was an exudate in 96.4% and a transudate in 3.6% of patients, with 91.3% showing a straw coloured ascites. Cirrhosis, detected by biopsy specimen, was a finding in 6.2% of patients.

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Unique Identifier:3092366

Authors: Martin RE. Bradsher RW.

Title: Elusive diagnosis of tuberculous peritonitis.

Source: Southern Medical Association Journal. 79(9):1076-9, 1986 Sep.

Abstract: Four patients with tuberculous peritonitis were diagnosed at our hospital in one year. In two patients it was only after surgery for iatrogenic bowel perforation that the diagnosis was made. The difficulty in recognizing this illness in those patients prompted a review of cases in Arkansas over the past nine years. A total of 27 cases have been documented; in 14 the diagnosis was made after considerable delay or during surgery for another diagnosis. Tuberculous peritonitis should be considered in any patient with ascites and chronic abdominal pain. CAS Registry/EC Number 0 (Antitubercular Agents).