Umbilical signs of peritoneal tuberculosis in children.
OBJECTIVE
To report the observation of involvement of the umbilicus with alteration of its morphology in association with peritoneal tuberculosis.


METHODS
This is a retrospective observational case series of abdominal tuberculosis (ATB) in children, treated in the department of pediatric surgery of a tertiary-care children's hospital in the period from January 2004 through April 2010.


RESULTS
Out of a total of 38 cases of ATB in children, 22(57.9%) were of the peritoneal type, 14(36.8%) were of the intestinal type, and 2(5.3%) involved the mesenteric lymph nodes. Of the patients manifesting with peritoneal tuberculosis, 11 cases (50%) had involvement of the umbilicus with changes in the umbilical shape and appearance. In seven cases the umbilicus was found retracted and transversely oriented (a slit-like "smiling" appearance) with loss of the umbilical hollow. In two cases there was puckering of the umbilicus. Other findings included umbilical erythema with inflammation in one patient and a fecal fistula at the umbilicus in another patient. While seven cases responded to treatment with antituberculous therapy (ATT), four cases underwent surgery (two laparotomy and two laparoscopy). Findings were similar in all four patients, consisting of adhered dilated bowel loops studded with tubercles which also covered the parietal peritoneum and the falciform ligament. All four cases responded to postoperative ATT.


CONCLUSIONS
Morphological changes of the umbilicus can provide an additional clue to the diagnosis of peritoneal tuberculosis in children.
Department of Pediatric Suregery, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, India.
Nitin
N
Pant
S Roy
SR
Choudhury
Amit
A
Gupta
Partap S
PS
Yadav
Jitendra Kumar
JK
Grover
Rajiv
R
Chadha
D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D014472:Umbilicus / Q000473:pathology*
D000995:Antitubercular Agents