Intestinal and peritoneal tuberculosis: changing trends over 10 years and a review of 80 patients.
BACKGROUND
To establish the efficiency of minimally invasive procedures in the diagnosis and management of abdominal (intestinal and peritoneal) tuberculosis (AT), I retrospectively and then prospectively evaluated clinical, physical and laboratory findings in patients with AT at a university general-surgery clinic. Diagnostic and therapeutic options were also considered.


METHODS
Data from the case records of 43 patients diagnosed with AT via laparotomy were collected and analyzed. On the basis of findings from that early analysis, a further 37 patients were studied prospectively. In the latter group, percutaneous aspiration, endoscopy and laparoscopy were used for diagnosis, except in cases with acute abdominal findings or failure of these diagnostic procedures. Morbidity and mortality rates and mean hospitalization time were evaluated for both groups.


RESULTS
In the early group of 43 patients, the morbidity rate was 30%; mortality, 12%; and median hospital stay, 18.3 days (standard deviation [SD] 6.2 d). The diagnosis was confirmed by laparotomy in 18 patients in the prospective group: laparoscopy or endoscopy in 10 and percutaneous drainage of an intra-abdominal abscess in 9. Changes in our approach to diagnostic procedures in the prospective group led to decreased morbidity (11%), mortality (0) and median hospital stay (9.3 [SD 4.7] d).


CONCLUSIONS
Minimally invasive procedures such as laparoscopic, endoscopic and percutaneous biopsy should be used for diagnosis of IPTB as a first step in diagnosis. Laparotomy should be performed only when complications develop or diagnosis remains unclear in spite of these diagnostic modalities.
Akgun
Yilmaz
Y
Department of General Surgery, Medical Faculty, Dicle University, Diyarbakir, Turkey. dryilmazakgun@yahoo.com
D005260:Female; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000601:surgery*