A case of tuberculous peritonitis in childhood (original) (raw)

Peritoneal Tuberculosis in Children Over the Last Decade: A Systematic Literature Review

2021

Background: Tuberculosis remains a public health issue. Peritoneal tuberculosis is an uncommon form of tuberculosis and it accounts for less than 1% of all tuberculosis cases in children. The aim was to asses experience and struggles in diagnosing peritoneal tuberculosis in children. Methods: Systematic review of literature from the PubMed database was conducted including cases of children with peritoneal tuberculosis during 2008-2019 years. Results: The search yielded 2309 potentially relevant articles, 11 met inclusion criteria with total number of 48 patients (4 our cases, 44 from the literature). 29 (60.4%) were males with the median age of 11 years and 19 (39.6%) females with the median age of 10. The contact with active tuberculosis was reported in 16 cases (33.3%). Tuberculin skin test was performed in 42 cases (87.5%) with only 43.7% positive. The mean time from symptoms presentation until hospitalization was 30.6 days. The most common symptoms were abdominal pain (70.8%), abdominal distention (66.7%) and fever (54.2%). The most common ultrasound ndings were free uid in pelvic cavity (70.8%) and enlarged mesenteric lymph nodes (52.1%). The majority of culture for Mycobacterium tuberculosis samples were negative. Surgery was performed in 36 (75%) cases with the most common ndings of tubercles (63.8%), peritonitis (41.6%) and ascites (36.1%). Histopathological biopsy evaluation was performed in 38 (79.2%) patients and in all cases tuberculosis granulomas were con rmed. Conclusions: Clinical presentation, laboratory and radiological ndings are nonspeci c for peritoneal tuberculosis in children. This systematic review shows that peritoneal tuberculosis was diagnosed by surgical intervention in most of the cases. Accordingly, we suggest the algorithm of less invasive procedures and tests before surgical intervention.

Peritoneal Tuberculosis in Infants: Diagnostic Challenges

European Journal of Pediatric Surgery Reports, 2018

Abdominal tuberculosis is rare in immunocompetent infants. We report on two infants with peritoneal tuberculosis (6 and 8 months) who underwent laparotomy for suspected intussusception. In the first patient, characteristic lesions of peritoneal tuberculosis were observed intraoperatively with presence of multiple granulations. Tuberculin intradermal reaction (IDRt) was positive and tuberculous contagium could be cultured. In the second patient, the IDRt and GeneXpert tests were negative. In both patients, the histopathological examination of the biopsy specimens confirmed the diagnosis of peritoneal tuberculosis. The clinical courses under tuberculostatic therapy were favorable in both cases.

Complicated and delayed diagnosis of tuberculous peritonitis

American Journal of Case Reports, 2013

Peritoneal tuberculosis is very rare in European countries. However, its incidence is increasing due to the continued immigration of people from endemic areas affected by tuberculosis. Case Report: The authors report a case of tuberculous peritonitis in a 46-year-old male patient from North Africa. The presenting symptoms of the disease were hiccups, dyspepsia, anorexia, and weight loss. Physical examination revealed an abdominal distension that suggested the presence of ascites. Subsequent investigations of ultrasound and computed tomography of the abdomen revealed the presence of massive ascites. A diagnostic laparoscopy went on to highlight a macro micronodular degeneration of the peritoneum. Histological examination showed the presence of epithelioid granulomas with typical Langhans cells with areas of caseous necrosis. The diagnosis of tuberculous peritonitis was then made, and the ascites quickly disappeared in response to the anti-mycobacterial therapy. The patient remained free of symptoms after 6 months of clinical follow-up. Conclusions: In this case the clinical diagnosis was complicated and delayed due to clinicians' suboptimal knowledge of and experience with this disease. This case demonstrates why laparoscopy with peritoneal biopsy should be the gold standard in any clinical suspicion.

Tuberculous peritonitis in an adolescent male

Journal of adolescent health care : official publication of the Society for Adolescent Medicine, 1988

Tuberculosis (TB) is a less common disease in adolescents than in any other age group. However, when it occurs it is extrapulmonary 10% of the time. We report a case of TB peritonitis in an adolescent patient who presented without a history of prior TB or TB exposure. Tuberculosis must be included in the differential diagnosis of any occult febrile illness, even in the absence of pulmonary disease.

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

European Journal of Gastroenterology & Hepatology, 2001

Objective To evaluate the clinical presentation, biochemical (ascites and serum) and laparoscopic ®ndings, and to assess the ef®cacy 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 6 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 ®ve 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 in¯ammation, and 4% non-speci®c ®ndings. The ascitic¯uid 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 ®rst 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 6 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¯uid are usually insuf®cient, 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 suf®cient to treat tuberculous peritonitis.

Problematic Diagnosis of a Patient with Tuberculosis Peritonitis

Proceedings of Surabaya International Physiology Seminar, 2017

Tuberculosis Peritonitis is a parietal or visceral peritoneal inflammation caused by Mycobacterium tuberculosis bacteria. Pathogenesis Tuberculosis peritonitis is preceded by infection with M. tuberculosis followed by spreading to the peritoneum. This is a report of a young female patient with a major complaint of overall abdominal pain and weight loss accompanied by other non-specific clinical symptoms such as fever, enlargement (ascites), with malnutrition, and a history of the patient's child being treated for tuberculosis lymphadenitis. The investigation showed anemia, erythrocyte sedimentation rate (ESR) and increased CRP, and ascites fluid analysis showed an exudate, ascites glucose ratio with blood < 0.96. Radiological examination of abdominal ultrasound found ascites, with abdominal CT scan examination finding thickening of the intestinal wall, supporting tuberculosis (TB) with bilateral ovarian cyst appearance. Diagnosis of tuberculosis peritonitis is based on histologic tissue examination by laparotomy. This laparotomy examination is performed because anamnesis, physical examination, and other support are not able to determine a definitive diagnosis. Furthermore, patients receive Fixed Drug Combination (FDC) therapy consisting of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol for 2 months, followed by a combination of Rifampicin and Isoniazid for 7-10 months. The prognosis of tuberculosis peritonitis is sufficient if the diagnosis is immediate and patients are adequately treated.

A Rare Case of Peritoneal Tuberculosis in a 21 Years Old Male Patient

Journal of Surgery Research and Practice, 2022

Tuberculosis is among the top 5 causes of death from infectious disease caused by Mycobacterium tuberculosis, it most frequently affects the lungs, although it can compromise the digestive tract, genitourinary, peritoneum, pleura, bones, lymph nodes and meninges, composing the group of extrapulmonary tuberculosis. Peritoneal involvement is the most common form of abdominal type representing 0.1 to 0.7% of all tuberculosis cases. With nonspecific symptoms, without of laboratory findings that would guide the search for Mycobacteria and imaging tests that overlap common in other pathologies, the diagnosis is difficult. In Abdominal Computed Tomography, ascites, smooth peritoneal thickening, densification of the mesentery root, lymphadenomegaly with central necrosis or calcification are observed. Laparoscopy with the biopsy and collection of ascitic fluid is used as a method for diagnosis. The mortality of abdominal tuberculosis can reach 15% and perforation of intestinal loops, malnutrition, anemia, hypoalbuminemia are the main complications. We present the case of a patient presenting recurrent umbilical hernia, whose diagnosis of peritoneal tuberculosis was made during surgery.

Tuberculosis in the Peritoneum: Not Too Rare After All

Case Reports in Gastroenterology, 2012

Peritoneal tuberculosis is rare with increased incidence rates in recent years. The absence of characteristic clinical features of the disease often makes its diagnosis difficult and elusive. We present the case of 61-year-old female with peritoneal tuberculosis. The patient suffered from abdominal pain for a period of 5 months prior to admission. The diagnosis was established on the basis of findings from an abdominal computed tomography scan, a chest radiograph and histopathological analysis of the laparoscopic resection of the two masses. The patient was discharged from hospital receiving a fourfold antituberculous treatment with isoniazid, rifampicin, pyrazinamide and ethambutol. A high index of suspicion and a combination of radiologic, endoscopic, microbiologic and histopathological examination achieves diagnostic accuracy and prevents clinical mismanagement.