Tuberculous peritonitis of the wet ascitic type: clinical features and diagnostic value of image-guided peritoneal biopsy.
BACKGROUND
Abdominal tuberculosis is still a medical problem in developing countries.


OBJECTIVE
To analyse the clinical, laboratory, ultrasonography and computed tomography findings and to discuss the diagnostic approach of 19 patients with peritoneal tuberculosis.


METHODS
Nineteen patients diagnosed in our department, with peritoneal tuberculosis (8 female, 11 male; mean age: 47.89 +/- 4.3 years) between 1996 and 2002, were studied retrospectively.


METHODS
All clinical, laboratory, radiological findings, and diagnostic methods were reviewed.


RESULTS
The most common symptoms and signs of the disease in these patients were abdominal pain, ascites, weight loss and night sweats. On conducting skin test, eight patients (42%) were found to be positive, while all the patients had elevated serum cancer antigen 125 levels, but acid-resistant bacilli could not be demonstrated on the direct preparation. In three patients (15.78%), the ascitic fluid culture was positive. The most common ultrasonographic and computed tomographic findings were ascites, septation in the ascites, peritoneal thickening, mesenteric and omental involvement. An abnormal chest X-ray, suggestive of previous tuberculosis was present in three patients. Diagnosis was made by image-guided percutaneous peritoneal biopsy in 18/19, and by histological examination of biopsy specimens obtained via laparoscopy in 1/19. Laparoscopy was only performed in 1 of the 19 patients due to lack of sufficient material for histological diagnosis by percutaneous biopsy. Of the biopsy specimens, 84% revealed caseating granulomas, while 16% were non-caseating. Acid-fast bacilli were seen on the Ziehl-Neelsen stain in 18 patients.


CONCLUSIONS
Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites. Image-guided percutaneous peritoneal biopsy seems to be a sufficient, safe and inexpensive method for diagnosis of peritoneal tuberculosis.
Vardareli
E
E
Department of Gastroenterology, Osmangazi University Medical School, Savas cad. Abaci apt. B bl. 63/21, 26020 Eskişehir, Turkey. eservardareli@yahoo.com
Kebapci
M
M
Saricam
T
T
Pasaoglu
O
O
Açikalin
M
M
D015746:Abdominal Pain / Q000175:diagnosis; D000243:Adenosine Deaminase / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000201:enzymology; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D005260:Female; D005334:Fever / Q000175:diagnosis; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D014395:Peritonitis, Tuberculous / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D000243:Adenosine Deaminase