IDDF2019-ABS-0223 Small bowel ultrasound finding of recurrent colic abdomen in peritoneal (dry type) tuberculosis

Abstract

Background Number of patients with recurrent colic abdominal pain without clear diagnostic, even many patients had very severe abdominal pain entered in hospitals several times without exact diagnostic in these at least health facilities. Objective To describe small bowel ultrasound finding of recurrent colic abdomen pain of peritoneal (dry type) tuberculosis. Methods This descriptive study conducted at some rural boundary islands: Saumlaki, Tanimbar, Moluccas (February-June 2010), St Elisabeth Hospital, Flores, (February 2012 -August 2013) and Stela Maris-Lukas Hilisimetano Hospitals South Nias-North Sumatera (April-July 2015). Patients whom diagnosed as peritoneal (dry type) tuberculosis clinically, based on sub-acute/chronic recurrent colic abdominal history, accompanied by diarrhea/constipation, weight loss, loss of appetite, chronic recurrent low-grade fever, night sweats, fatigue and malabsorption symptoms; doughy abdomen with dam-board phenomena according to peritoneal dry type tuberculosis; high blood sedimentation rate and lymphocyte increased; and the X-ray shown pulmonary tuberculosis. Small bowel ultrasound examined with convex probe 3.5–6 MHz as the only available ultrasound equipment at that time by one certified ultrasound internal medicine specialist. Small bowel wall thickness (of 80 patients) in the dullness pain area were compared within the tympanic area. Results N=1929 adult, >15–78y (Saumlaki 329, Flores 1299, South Nias 301). The recurrent colic abdominal pain with tenderness were associated with doughy and dull area of dam-board phenomena of peritoneal tuberculosis. No tenderness on tympanic area. Ultrasound finding in the dullness area were hypoperistaltic, thickening heterogenic hypoechoic of the small bowel wall, loss differentiation and irregular margin of the wall in addition to several round nodular structures (patchy hyper echoic non-shadowing with an irregular hypoechoic rim) within the wall and narrowing of the lumen. The mean of small bowel wall thickness in the dull area were (6,2–22,6 mm, mean 12,44 mm ( 2,63x ) compared with in tympanic area were (3,7–4,8 mm, mean 4,6 mm). Conclusions Small bowel ultrasound finding of the recurrent colic abdomen was associated with thickening of small bowel wall and narrowing of its lumen in the dull area of dam-board phenomena in peritoneal (dry type) tuberculosis.