The role of surgery in management of tuberculous peritonitis

Abstract

Background: Tuberculous peritonitis is a serious condition with rising prevalence in recent years. The most common site of involvement is the ileo-caecal region. Treatment with standard antituberculous drugs is usually highly. Surgery is usually reserved for patients who have developed complications, obstruction or not responding to medical management. The aim of this study was to describe the surgical management of tuberculous peritonitis.Methods: This study was carried out at Al-Karama Teaching Hospital between December 2015 to June 2018. A sixty patients with proved tuberculous peritonitis. It was a prospective study in which the records of the patients operated upon as peritonitis or acute intestinal obstruction and whose diagnosis was later confirmed as tuberculosis on histopathology were analysed with regards clinic-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality.Results: Their age range was between 20-39 years, 25 (62.5%) were females and 15 (37.5) were males, abdominal distension and pallor were a common clinical finding 92.5% and 90% prospectively and 42.5 % of the patients have their complaints for 2-3 months, while history of pulmonary tuberculosis was present in 22.5% of the patients only. In 50% of the patients there were no important findings on chest X-ray. Ascites was positive in 82.5% of patients on abdominal sonography while on diagnostic laparoscopy in 45% of patients the findings were ascites with peritoneal and bowel adhesions.Conclusions: Early diagnosis is the key factor in avoiding systemic and local complications of intestinal tuberculosis. Laparoscopy is the minimal invasive technique for definitive diagnosis with minimal sides effects.