Tuberculosis Study Guide - M.M. Savula 2002

Extrapulmonary tuberculosis
Peritoneal tuberculosis (tuberculous peritonitis)

Pathogenesis. Peritoneal involvement occurs via hematogenous or lymphogenous spread of infection, as well as by direct contact through the extension of the specific process from other Organs, such as the mesenteric Lymph Nodes, fallopian tubes, or intestines. Initially, tubercular eruptions appear on the Peritoneum, which remain clinically silent. Subsequently, some cases are dominated by fluid accumulation in the peritoneal cavity (exudative form), while others involve The formation of extensive adhesions with minimal fluid trapped between them (adhesive or dry form). Occasionally, adhesions between the intestines, omentum, and peritoneum lead to the formation of nodular, tumor-like masses (nodular-tumor form) containing encysted caseous purulent material. In the exudative form, serous (predominantly lymphocytic), seropurulent, or hemorrhagic exudate accumulates in the peritoneal cavity.

Clinical presentation and Diagnosis. Tuberculous Peritonitis usually develops in individuals with specific tuberculous lesions in other organs. Patients complain of abdominal pain unrelated to food intake, loss of appetite, low-grade fever, bowel disturbances, and occasionally vomiting. The Clinical presentation of peritonitis can sometimes mimic Chronic Pancreatitis or appendicitis.

On physical examination, the Tongue is coated with a white fur and is moist; the abdomen is distended and tender to Palpation. Abdominal Muscle guarding and Blumberg's sign (rebound tenderness) are equivocal. With a significant accumulation of exudate, the abdomen is increased in size, and shifting dullness can be detected in the flanks. In the presence of adhesive processes, tumor-like masses may be palpated in the Abdominal cavity, and intestinal obstruction may develop.

The complete Blood count is normal, or there may be mild leukocytosis and a slightly elevated ESR.

Tuberculin Skin tests are positive in patients with tuberculous peritonitis. In unclear cases, a subcutaneous tuberculin test (Koch's test) is performed, which may trigger a focal reaction, such as increased abdominal pain.

To establish the diagnosis, abdominal paracentesis is performed, followed by cytological and MICROBIOLOGICAL EXAMINATION OF the fluid. Detection of MTB confirms the diagnosis. In unclear cases, peritoneal needle biopsy and laparoscopy are performed. Sometimes, even during laparotomy, it is difficult to differentiate tuberculous peritonitis from metastatic Peritoneal carcinomatosis. Therefore, histological examination of the biopsy specimen is crucial.

Treatment. Standard antituberculous Chemotherapy is administered, and glucocorticoids are prescribed to reduce exudation and prevent excessive adhesion formation. Good results are achieved by introducing oxygen into the peritoneal cavity (pneumoperitoneum). Surgical treatment is indicated in cases of recurrent intestinal obstruction.