Clinical, laparoscopic and histological features in 71 patients with tuberculous peritonitis

Abstract

Objective: To report the clinical, laparoscopic and histological features of tuberculous peritonitis diagnosed in an area with a high prevalence of tuberculosis. Patients and methods: Between 1984 and 1989, 71 cases of tuberculous peritonitis (35 men, 36 women, mean age 35 years, range 15–71 years) were diagnosed at our centre. All patients underwent a physical examination, standard laboratory and tuberculin skin tests, as well as tests for acid-fast bacilli, and laparoscopy with peritoneal and/or liver biopsy. Results: Clinical signs included emaciation (n = 64), ascites (n = 57), fever (n = 46) and abdominal pain (n = 13). The tuberculin skin test was positive in 58 patients. Ascites fluid was always an exudate (mean protein content 65g/l) with a lymphocyte count >80% of the total white blood cell count, while tests for acid-fast bacilli were negative. Laparoscopic findings included typical peritoneal tubercles (n = 60), either disseminated (n = 43) or localized (n = 17, four of which were pure pelvic locations), associated with hyperaemia (n = 31 ) or adhesions (n = 28), or alone (n = 11). The features observed on the liver were: tubercles (n = 26), disseminated (n = 18) or localized (n = 6); adhesions (n = 6); normal macroscopic features (n = 10), or cirrhosis (n = 3). Histological findings comprised granuloma with or without caseation (n = 56), always in patients with laparoscopic peritoneal tubercle features; lymphohistiocytosic infiltration (n = 12), and non-specific inflammation (n = 3). On liver biopsy (n = 20), diagnostic features included granuloma with caseation (n = 12, eight of whom had adhesions on laparoscopy); lymphohistiocytosic infiltration (n = 2); cirrhosis (n = 13), and normal features (n = 13). Conclusion: Laparoscopy remains the most suitable procedure for the diagnosis of tuberculous peritonitis. Atypical laparoscopic features, such as pelvic tubercles only or adhesions only, may be present. Liver biopsy may be useful for diagnosis in such patients.