Diagnostic challenges of tuberculosis peritonitis in upper Egypt

Abstract

Background Tuberculosis (TB) is a major global health problem. Peritoneal tuberculosis involves the omentum, intestinal tract, liver, spleen, or female genital tract in addition to the parietal and visceral peritoneum. It accounts for ∼1–2% of all cases of tuberculosis. Aims of the study The aims of this study was to analyze the clinical, laboratory, and imaging findings in patients with TB peritonitis and to evaluate the diagnostic methods. Patients and methods This prospective, observational study was carried out on patients with obscure ascites. All patients were subjected to history taking, clinical examination, and laboratory investigations. Ascitic fluid analysis and calculation of serum-ascites albumin gradient were done. Abdominal ultrasound (US) and computed tomography scans were performed. Laparoscopic-guided biopsies from peritoneal tubercle and unhealthy omentum were taken for histopathology and culture analysis. Results The study included 22 cases. Approximately 77.3% were female. The mean age was 42.6±15.1. More than two-thirds of the cases had fever, pain, and abdominal swelling. No portal hypertensive ascites was found in 86.4% of cases. Ascitic fluid cytology revealed lymphocytes in 91%. In abdominal US, ascites was the only finding in 59% of cases; however, adhesion was found in 22.8% of cases. Lymphadenopathy was observed in 13.6% of cases undergoing abdominal US. During laparoscopy, small tubercles on the peritoneum, omentum, and/or intestine with extensive adhesions were the predominant findings. Regarding the histopathologic findings, TB granuloma was predominant in 80% of cases. Conclusion TB peritonitis was common among middle-aged females. Ascites and adhesions were the commonest findings. Laparoscopy and histopathology were the best diagnostic modalities.