Tuberculosis - I.T. Pyatnochka 2005

Extrapulmonary Tuberculosis
Tuberculosis of the Intestines, Peritoneum, and Mesenteric Lymph Nodes

Tuberculosis of the mesenteric Lymph Nodes (mesadenitis) is the most common form of abdominal tuberculosis, although overall it is quite rare. It is most frequently observed in children and adolescents, coinciding with the primary period of tuberculosis infection, though it can also develop in secondary forms of tuberculosis. In the Pathogenesis of mesadenitis, the alimentary route of infection plays a significant role, often caused by the bovine strain of Mtb.

Infiltrative, caseous, and indurative (fibrous) forms of mesadenitis are distinguished.

The Clinical presentation of tuberculous mesadenitis is characterized by diverse symptoms. The disease has a gradual onset and a prolonged, chronic course. Patients most commonly complain of intermittent abdominal pain located to the right of the umbilicus. The pain intensifies with physical exertion, after eating, and upon abdominal Palpation. Often, abdominal pain is accompanied by other dyspeptic disorders (nausea, vomiting, flatulence, bowel irregularities) against the Background of moderately pronounced symptoms of tuberculosis intoxication.

Diagnosis. Physical examination reveals abdominal distension, tension of the abdominal wall, and tenderness upon palpation in the affected area. Sometimes, a conglomerate of mesenteric lymph nodes can be palpated. In cases of a prolonged course of the disease, petrifications may form, which are visible on abdominal radiography (Fig. 29). Reliable Methods for detecting enlarged lymph nodes include Ultrasound examination, computed tomography, and, above all, laparoscopy with biopsy.

Treatment of patients is carried out with isoniazid, rifampicin, pyrazinamide, and streptomycin (for 2 months) over a period of 6-8 months. Occasionally, laparotomy and surgical removal of the affected lymph nodes are performed.

Intestinal tuberculosis usually develops As a result of the progression of Pulmonary Tuberculosis, mesadenitis, or other Organs, i.e., in Primary and secondary tuberculosis. Mtb penetrate the intestines via hematogenous, lymphogenous, and, more rarely, sputum-borne routes through the ingestion of infected sputum. In recent decades, intestinal tuberculosis has become rare.

Pathoanatomical changes in intestinal tuberculosis are predominantly observed in the terminal ileum, cecum, and ascending colon. Tubercles, infiltrates, and ulcers appear on the intestinal wall, and scars remain after healing. Perforation of an ulcer into the Abdominal cavity is possible.

The clinical picture of intestinal tuberculosis is atypical, and diagnosis is difficult. Dyspeptic disorders and intermittent pain occur most frequently in the ileocecal region. Stool contains mucus impurities, and sometimes Blood. Mtb are frequently found in the mucus. X-ray Examination is of great diagnostic importance (the affected bowel segment is spastic with filling defects in the form of serrated contours, contrast spots, etc.).

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Fig. 29. Tuberculous mesadenitis (calcification)

Treatment. With timely diagnosis, it responds well to therapy with antimycobacterial drugs (isoniazid, rifampicin, pyrazinamide, or ethambutol). The average duration of Chemotherapy is 6-8 months. In case of intestinal ulcer perforation or intestinal obstruction, Surgical treatment is indicated.

Peritoneal tuberculosis occurs via hematogenous, lymphogenous, and contact pathways in tuberculosis of the abdominal organs or more distant organs. Peritoneal tuberculosis as an independent disease is a rarity.

Exudative and fibrinose (plastic) forms of Peritonitis are distinguished. In the exudative form, exudate accumulates in the abdominal cavity; the Peritoneum is thickened, hyperemic, and covered with tuberculous tubercles and caseous plaques.

The plastic form of peritonitis arises as a complication of mesadenitis or intestinal tuberculosis and is characterized by numerous adhesions and encysted pockets of exudate.

The clinical presentation of peritoneal tuberculosis combines the syndrome of tuberculosis intoxication and dyspeptic disorders.

The diagnosis of tuberculous peritonitis is based on the results of cytological and MICROBIOLOGICAL EXAMINATION OF the abdominal exudate, and, if necessary, peritoneal biopsy during laparoscopy. Tuberculin tests, particularly the Mantoux test, are of major importance for clarifying the Etiology of the disease.

Treatment. The main method of treating patients with tuberculous peritonitis is prolonged (8-12 months) antimycobacterial therapy combined with desensitizing agents, Vitamins, and frequently glucocorticoids. When a significant amount of exudate is present in the abdominal cavity, its evacuation is performed; in case of intestinal obstruction, surgical treatment methods are used.