[DIGESTIVE TUBERCULOSIS IN THE EDGARDO REBAGLIATI MARTINSHOSPITAL (HNERM): A RETROSPECTIVE STUDY OVER A FIVE-YEAR PERIOD (1993-1998)]
INTRODUCTION: Tuberculosis is a common disease in Peru.Although there is evidence of the decrease in lung infections, abdominaltuberculosis and other extrapulmonary varieties show an increase in incidence. This study was performed in order lo determine incidence, clinical picture, diagnostic methods and procedures, compromised tissues and organs and treatment given to patients with Digestive Tuberculosis in the Hospitalization Area of the Digestive Disease Department of the Peruvian "Edgard Rebagliati Martins" Hospital in Lima-Peru, a 1-500 bed Center. METHODS: 77 clinical records were reviewed, of patients discharged and diagnosed with Abdominal or Digestive Tuberculosis between January 1993 to May 1998. Fifty eight of these records fuifilled the requirements. Results: The mean duration of symptoms was 5.49 months. The clinical characteristics are unspecific. The most frequent symptoms were weight loss, chronic diarrhea, abdominal pain and fever (over 70% of cases). The most common signs were abdominal pain, ascites and cachexia in more than 50% of the cases. The Laboratory tests are typical for chronic diseases and emphasize the erythrocite sedimentation rate that was high in 98% of cases. Adenosin Deaminase Assay (ADA) in ascific fluid was high in 95% of cases when peritoneal compromise was present and fluid could be obtained. The Radiology tests such as barium colon enema and intestinal transit tests were helpful together with Ultrasound and Computerized Tomography in detecting the intestinal location of the disease, the organs that had been affected as well assisting as to the decision to perform further invasive tests. We found 27.58% with gastrointestinal location, 43% with only peritoneal affection and 27.58% of mixed forms (gastrointestinal plus peritoneal). The endoscopic procedures have been decisive for the diagnosis of up to 90% of cases and Laparascopy has been of value, in up to 70% of the cases, for the detection of peritoneal affection. Six patients of our series have required exploratory Laparascopy for diagnosis. Treatment has been effective in 86% of cases. CONCLUSION: The diagnosis of Digestive Tuberculosis continues to be long, tedious and expensive. The incidence of this disease has increased in our Hospitalization Center since 1993. All cases reviewed require invasive procedures (endoscopic) or surgery for their final diagnosis. We emphasize the use of Laparoscopy tests for the evaluation of p0eritoneal affection.
Yriberry
Simón
S
Cervera
Zenón
Z
Soriano
César
C
Frisancho
Oscar
O
Machado
Alberto
A
Zumaeta
Eduardo
E