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Mahajan M, Prasad ML, Kumar P, Kumar A, Chatterjee N, Singh S, Marandi S, Prasad MK. An Updated Systematic Review and Meta-Analysis for the Diagnostic Test Accuracy of Ascitic Fluid Adenosine Deaminase in Tuberculous Peritonitis. Infect Chemother 2023; 55:264-277. [PMID: 37407244 DOI: 10.3947/ic.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Tuberculous peritonitis is difficult to diagnose due to its non-specific clinical manifestations and lack of proper diagnostic modalities. Current meta-analysis was performed to find the overall diagnostic accuracy of adenosine deaminase (ADA) in diagnosing tuberculous peritonitis. MATERIALS AND METHODS PubMed, Google Scholar, and Cochrane library were searched to retrieve the published studies which assessed the role of ascitic fluid ADA in diagnosing tuberculous peritonitis from Jan 1980 to June 2022. This meta-analysis included 20 studies and 2,291 participants after fulfilling the inclusion criteria. RESULTS The pooled sensitivity was 0.90 (95% confidence interval [CI]: 0.85 - 0.94) and pooled specificity was 0.94 (95% CI: 0.92 - 0.95). The positive likelihood ratio was 15.20 (95% CI: 11.70 - 19.80), negative likelihood ratio was 0.10 (95% CI: 0.07 - 0.16) and diagnostic odds ratio was 149 (95% CI: 86 - 255). The area under the summary receiver operating characteristic curve was 0.97. Cut- off value and sample size were found to be the sources of heterogeneity in the mete-regression analysis. CONCLUSION Ascitic fluid ADA is a useful test for the diagnosis of tuberculous peritonitis with good sensitivity and specificity however, with very low certainty of evidence evaluated by Grading of Recommendations, Assessment, Development and Evaluation approach. Further well- designed studies are needed to validate the diagnostic accuracy of ascitic fluid ADA for tuberculous peritonitis.
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Affiliation(s)
- Mayank Mahajan
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | | | - Pramod Kumar
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Neha Chatterjee
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Shreya Singh
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sujeet Marandi
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Cheng BW, Xie PW, Miao YS, Li GH. Feasibility and Safety of Transgastric Natural Orifice Transluminal Endoscopic Surgery in the Diagnosis of Ascites of Unknown Origin. J Laparoendosc Adv Surg Tech A 2023; 33:200-204. [PMID: 36201261 DOI: 10.1089/lap.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the feasibility and safety of transgastric natural orifice transluminal endoscopic surgery (TG-NOTES) combined with biopsy in the diagnosis of unknown ascites. Method: This retrospective study used data from the first affiliated hospital of Nanchang university on 51 patients who were diagnosed with ascites of unknown origin between January 2013 and May 2019 and experienced peritoneal biopsy through TG-NOTES. The outcome measures included diagnostic accuracy and procedure-related adverse events. Results: TG-NOTES was performed successfully in 46 of 51 patients, tuberculous ascites in 38 cases, carcinomatous ascites in 4 cases, cirrhotic ascites in 1 case, and 3 cases showed no obvious abnormalities in pathological result. Five cases failed to be diagnosed because of abdominal adhesions. The diagnostic rate of TG-NOTES was 84.3%. There were no severe procedure-related adverse events and no mortality. All patients had good wound healing and no complaint of discomfort on follow-up. Conclusion: The majority of ascites of unknown origin can be expounded through TG-NOTES combined with biopsy without severe complication, therefore, it is a feasible and safe method to detect the cause of unexplained ascites.
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Affiliation(s)
- Bo-Wen Cheng
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Pei-Wei Xie
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Yin-Shui Miao
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
| | - Guo-Hua Li
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China
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Zhou R, Qiu X, Ying J, Yue Y, Ruan T, Yu L, Liu Q, Sun X, Wang S, Qu Y, Li X, Mu D. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis. Front Public Health 2022; 10:938544. [PMID: 36211645 PMCID: PMC9533650 DOI: 10.3389/fpubh.2022.938544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background and aim Abdominal tuberculosis (TB) is a common type of extrapulmonary TB with an insidious onset and non-specific symptoms. Adenosine deaminase (ADA) levels increase rapidly in the early stages of abdominal TB. However, it remains unclear whether ADA serves as a diagnostic marker for abdominal TB. Methods We performed a systematic literature search for relevant articles published in PubMed, Web of Science, Cochrane Library, and Embase up to April 2022. First, we used the Quality Assessment of Diagnostic Accuracy Studies tool-2 (QUADAS-2), to evaluate the quality of the included articles. Bivariate and hierarchical summary receiver operating characteristic (HSROC) models were then utilized to analyze pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC). In addition, we explored a subgroup analysis for potential heterogeneity and publication bias among the included literature. Results Twenty-four articles (3,044 participants, 3,044 samples) which met the eligibility criteria were included in this study. The pooled sensitivity and specificity of ADA for abdominal TB detection were 93% [95% confidence interval (CI): 0.89-0.95] and 95% (95% CI: 0.93-0.96), respectively. PLR and NLR were 18.6 (95% CI: 14.0-24.6) and 0.08 (95% CI: 0.05-0.12), respectively. DOR and AUROC were 236 (95% CI: 134-415) and 0.98 (95% CI: 0.96-0.99), respectively. Furthermore, no heterogeneity or publication bias was found. Conclusions Our meta-analysis found ADA to be of excellent diagnostic value for abdominal TB and could be used as an auxiliary diagnostic tool. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022297931.
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Affiliation(s)
- Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,*Correspondence: Junjie Ying
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Tiechao Ruan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Luting Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qian Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xuemei Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Shaopu Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xihong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,Dezhi Mu
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Sumalani KK, Akhter N, Chawla D, Rizvi NA. Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay. Pneumologie 2021; 76:92-97. [PMID: 34847611 DOI: 10.1055/a-1666-5851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The diagnosis of pleural tuberculosis remains a clinical challenge due to the paucibacillary nature of disease. Medical thoracoscopy remains the gold standard in diagnosing tuberculous pleuritis. OBJECTIVE To establish the diagnostic yield of sago-seed thoracoscopic appearance of pleura in tuberculosis and its correlation with histopathology, tissue AFB culture and tissue Xpert MTB/Rif assay. METHODS All consecutive patients with lymphocytic exudative pleural effusion, who fulfilled inclusion criteria of the study underwent medical thoracoscopy under local anesthesia and pleural tissue was sent for histopathology, AFB culture and Xpert MTB/Rif assay. Chronic granulomatous inflammation on histopathology and response to anti-tuberculous treatment was taken as reference standard for diagnosis of tuberculous pleurisy. RESULTS A total of 249 patients were included in the study, out of which 168 had effusion secondary to tuberculosis. Sago-like nodules visualized on thoracoscopy had a sensitivity of 58.9 %, specificity of 92.6 % and diagnostic accuracy of 69.88 % for pleural tuberculosis. There is a strong association between the presence of sago-like nodules and detection of mycobacterium tuberculosis on Xpert MTB/Rif assay and AFB culture of pleura (p-value 0.007). CONCLUSION Sago seed nodules on pleura have a high positive predictive value for tuberculous pleurisy. In high endemic countries patients with this finding on thoracoscopy can be commenced on anti-tuberculous treatment before histopathology or culture results are available.
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Affiliation(s)
- Kamran Khan Sumalani
- Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Nousheen Akhter
- Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Dimple Chawla
- Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Nadeem Ahmed Rizvi
- Department of Pulmonology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Maamatou W, Jabloun A, Daib A, Jarray L, Ben Abdallah R, Hellal Y, Trabelsi F, Gharbi Y, Kaabar N. Place of Laparoscopy in Peritoneal Tuberculosis. J Laparoendosc Adv Surg Tech A 2021; 31:1480-1484. [PMID: 34748433 DOI: 10.1089/lap.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Peritoneal tuberculosis (PT) is a rare form of extrapulmonary tuberculosis in children. The diagnosis is difficult because of its clinical polymorphism. Laparoscopy is the gold standard to make the diagnosis by exploring and performing peritoneal biopsies. Our aim was to show the place of laparoscopy in the diagnosis of PT, to compare the anatomopathological results of peritoneal biopsies with a macroscopic appearance to quick start antituberculosis treatment. Case Reports: We reported 4 patients with PT, 3 girls and 1 boy. The middle age was 9 years old. The revealing symptomatology was ascites in all cases. Radiological exploration was not contributing. Laparoscopy was performed for all patients. The exploration revealed an agglutination of the intestinal loops with the presence of whitish micronodules scattered over the entire abdominal cavity. Peritoneal biopsies were done in all cases. Histological examination confirmed the diagnosis of PT in all patients and antituberculosis treatment was introduced. There was a good clinical evolution with a follow-up of 30 months. Conclusion: PT is a public health problem due to its clinical and biological polymorphism. Laparoscopy with peritoneal biopsies remains the essential means for the diagnosis of this pathology in children.
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Affiliation(s)
- Wafa Maamatou
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Asma Jabloun
- Department of Surgery "A", Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Aida Daib
- Department of Surgery "A", Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Leila Jarray
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | | | - Youssef Hellal
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Fatma Trabelsi
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Youssef Gharbi
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Nejib Kaabar
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia.,Department of Surgery "A", Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Diagnosis of Peritoneal Tuberculosis from Primary Peritoneal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910407. [PMID: 34639707 PMCID: PMC8508481 DOI: 10.3390/ijerph181910407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022]
Abstract
Peritoneal tuberculosis (PTB) is an uncommon extrapulmonary infection mimickng primary peritoneal cancer (PPC). We retrospectively included 23 women with PTB and 47 women with PPC treated in a medical center to study the clinical and radiological features that differentiate PTB from PPC. Body temperature above 38 °C was a unique feature of PTB (34.7% versus 0%, p < 0.001). Body Mass Index (BMI) was lower (21.9 ± 3.7 versus 25.2 ± 4.1, p = 0.003), white blood cell (WBC) count was lower (5179.6 ± 1502.2 versus 7716.2 ± 2741.8, p < 0.001), and CA-125 level was lower (508.0 ± 266.1 versus 2130.1 ± 2367.2 U/mL, p < 0.001) in PTB compared with PPC. Imaging detected more pulmonary infiltration and consolidation (52.2% versus 6.4%, p < 0.001), and less omental/mesentery changes (52% versus 83%, p < 0.001) in PTB compared with PPC. The operated patients received earlier treatment compared to patients without operation (7.9 ± 5.3 days versus 17.2 ± 11.0 days, p = 0.010). In conclusion, fever above 38 °C, lower BMI, lower WBC count, less elevated CA-125 level, and imaging of less omental involvement were features of PTB differentiated from PPC.
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Dahale AS, Puri AS, Sachdeva S, Agarwal AK, Kumar A, Dalal A, Saxena PD. Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:168-176. [PMID: 34565786 DOI: 10.4166/kjg.2021.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
Backgrounds/Aims Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.
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Affiliation(s)
| | - Amarender Singh Puri
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Anil K Agarwal
- Department of Gastrointestinal Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Pritul D Saxena
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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Van Slambrouck J, Vlasselaers J, Devos B. A case report of peritoneal tuberculosis diagnosed by laparoscopy in a low prevalence setting. Acta Chir Belg 2021; 121:269-273. [PMID: 31738664 DOI: 10.1080/00015458.2019.1693152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Peritoneal tuberculosis is a rare extrapulmonary manifestation of tuberculosis. Considering the diagnosis of peritoneal tuberculosis in a low prevalence setting can be vital for further clinical management in selected patients. In a young male with migration background, presenting with generalised abdominal pain, computed tomography revealed ascites, omental and peritoneal thickening and enlarged mesentery lymph nodes. Computed tomography also revealed a distal ureteral calculus at the right vesico-ureteral junction. Diagnostic laparoscopy showed a nodular degeneration of the visceral and parietal peritoneum and adhesions in the upper peritoneal cavity. Tissue biopsy of peritoneal lesions and omentum was performed. Histological examination revealed granulomas with central caseating necrosis. The ureteral stone was removed by means of ureteroscopy. Prompt diagnosis of peritoneal TB made possible to start anti-tuberculous chemotherapy without significant delay. The low prevalence of peritoneal TB demands a high index of suspicion in patients at risk presenting with nonspecific abdominal complaints, ascites and constitutional symptoms. Diagnostic laparoscopy leads to a quick diagnosis by direct visualisation of the peritoneal cavity and tissue biopsy. When available, it is the diagnostic procedure of choice to confirm tuberculous peritonitis. The concomitant presentation of tuberculous peritonitis and ureteral calculus can be explained by hypercalciuria in granulomatous disease.
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Affiliation(s)
- Jan Van Slambrouck
- Department of General Surgery, Academic Hospital Zeno, Knokke-Heist, Belgium
| | - Johan Vlasselaers
- Department of General Surgery, Academic Hospital Zeno, Knokke-Heist, Belgium
| | - Bart Devos
- Department of General Surgery, Academic Hospital Zeno, Knokke-Heist, Belgium
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Abstract
Gastrointestinal (GI) tuberculosis (TB) remains a significant problem worldwide, and may involve the luminal GI tract from oral cavity to perianal area in addition to associated viscera and peritoneum. Although GI TB more commonly affects immunocompromised hosts, it can also occur in immunocompetent people. Diagnosis is difficult because it usually mimics a malignancy or inflammatory bowel disease. A high index of clinical suspicion and appropriate use of combined investigative methods help in early diagnosis, and reduce morbidity and mortality. Anti-TB therapy is the same as for pulmonary disease, and invasive and specialized interventions are reserved for selected complications.
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Affiliation(s)
- Haluk Eraksoy
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, TR-34093 Istanbul, Turkey.
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Salman MA, Salman AA, Hamdy A, Abdel Samie RM, Ewid M, Abouregal TE, Seif El Nasr SM, Elkassar H, Abdallah A, Yousef M, Mohammed Ismail AA, Alsebaey A, Matter M. Predictive value of omental thickness on ultrasonography for diagnosis of unexplained ascites, an Egyptian centre study. Asian J Surg 2020. [DOI: https:/doi.org/10.1016/j.asjsur.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Salman MA, Salman AA, Hamdy A, Abdel Samie RM, Ewid M, Abouregal TE, Seif El Nasr SM, Elkassar H, Abdallah A, Yousef M, Mohammed Ismail AA, Alsebaey A, Matter M. Predictive value of omental thickness on ultrasonography for diagnosis of unexplained ascites, an Egyptian centre study. Asian J Surg 2020. [DOI: https://doi.org/10.1016/j.asjsur.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Li SL, Zhao E, Zhao L, Wang ZK, Li W. Transvaginal natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin. Gastrointest Endosc 2019; 89:872-877. [PMID: 30391254 DOI: 10.1016/j.gie.2018.09.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Natural orifice transluminal endoscopic surgery (NOTES) has been established in animal models and human studies, but few clinical studies have investigated transvaginal NOTES in the diagnosis of unexplained refractory ascites. We aimed to assess the feasibility, efficacy, and safety of transvaginal NOTES for the diagnosis of unexplained ascites in female patients. METHODS A prospective study was done involving 3 female patients with unexplained ascites. After general anesthesia and disinfection, a 1.0-cm incision was made in the posterior fornix of the vagina. A gastroscope was inserted into the abdominal cavity through the transvaginal incision and an artificial pneumoperitoneum was created; NOTES peritoneoscopy was performed to scrutinize the pathologic changes. Endoscopic biopsy specimens were obtained for pathologic examination. The transvaginal incision was closed by direct suturing. RESULTS Transvaginal NOTES for diagnostic peritoneoscopy was successfully performed in 3 patients. The mean operative time was 61 minutes. The estimated blood loss was 5 to 10 mL. The pathologic diagnoses were tuberculosis for all patients, and the symptoms and ascites disappeared after antituberculosis therapy. During the 4-year follow-up, no clinically significant adverse events occurred in any patient after NOTES. No patient experienced an annex inflammation, vaginitis, dyspareunia, or sexual dysfunction. All patients were comfortable and satisfied with the nonscarring surgical procedure. CONCLUSIONS Transvaginal NOTES for the diagnosis of unexplained ascites is feasible, effective, and safe. This method had no long-term effect on female sexual function and is particularly suitable for women who have special aesthetic requirements. (Clinical trial registration number: ChiCTR-TRC-10001053.).
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Affiliation(s)
- Shu-Ling Li
- Department of Gastroenterology and Hepatology, the General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Enfeng Zhao
- Department of Gastroenterology and Hepatology, the General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Li Zhao
- Department of Gastroenterology and Hepatology, Hainan Branch of the Chinese PLA General Hospital, Hainan, China
| | - Zi-Kai Wang
- Department of Gastroenterology and Hepatology, the General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, the General Hospital of the Chinese People's Liberation Army, Beijing, China
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Predictive value of omental thickness on ultrasonography for diagnosis of unexplained ascites, an Egyptian centre study. Asian J Surg 2019; 43:13-19. [PMID: 30910377 DOI: 10.1016/j.asjsur.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 02/08/2023] Open
Abstract
Etiology of ascites of unknown origin varies with geographic area and ethnic origin. Tuberculous peritonitis and peritoneal carcinomatosis constitute a considerable proportion of patients. Differentiation between both is a major challenge. The role of omental thickness (OT) by ultrasonography to predict risk of malignancy in unexplained ascites. This prospective study was done at Kasr Alainy School of Medicine, Cairo University and included 100 adults with unexplained ascites and thickened omentum (>15 mm) on ultrasonography. An expert performed ultrasonography to assess peritoneum and peritoneal cavity and measure OT. Ascites was assessed regarding volume, echogenicity, and loculation. The ascitic fluid was analyzed to measure lactate dehydrogenase, adenosine deaminase, and total leukocytic count. Laparoscopic exploration with biopsy was done for final diagnosis that divided the patients into; TB Group (n = 44) and peritoneal carcinomatosis group (n = 56). Main Outcome Measures were to determine degree of omental thickness as a predictor of malignancy risk in unexplained ascites and other ultrasonographic features to predict malignancy risk including omental echogenicity and results of diagnostic ascitic tapping. We found that OT was greater in the PC group compared to the TB group (24.6 ± 4.6 mm vs. 17.9 ± 3.0 mm, respectively, p < 0.001). Higher frequency of hypoechogenicity, irregular peritoneal surface, omental cakes, and lymph nodes was seen in PC Group. ADA, TLC, and relative lymphocyte count were higher in TB group. Omental thickness ≥19.5 mm has a sensitivity of 89.3%, specificity of 84.1% to diagnose PC. We can conclude that omental thickness >19 mm is a sensitive and specific predictor of malignancy in patients with unexplained ascites.
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Wang SB, Ji YH, Wu HB, Wang QS, Zhou WL, Lv L, Shou T, Hu J. PET/CT for differentiating between tuberculous peritonitis and peritoneal carcinomatosis: The parietal peritoneum. Medicine (Baltimore) 2017; 96:e5867. [PMID: 28079823 PMCID: PMC5266185 DOI: 10.1097/md.0000000000005867] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Tuberculous peritonitis (TBP) mimics peritoneal carcinomatosis (PC). We aimed to investigate the discriminative use of PET/CT findings in the parietal peritoneum. MATERIALS AND METHODS Parietal peritoneal PET/CT findings from 76 patients with TBP (n = 25) and PC (n = 51) were retrospectively reviewed. The lesion locations were noted as right subdiaphragmatic, left subdiaphragmatic, right paracolic gutters, left paracolic gutters, and pelvic regions. The distribution characteristic consisted of a dominant distribution in the pelvic and/or right subdiaphragmatic region (susceptible area for peritoneal implantation, SAPI) (SAPI distribution), a dominant distribution in the remaining regions (less-susceptible area for peritoneal implantation, LSAPI) (LSAPI distribution), or a uniform distribution. PET morphological patterns were classified as F18-fluorodeoxyglucose (F-FDG) uptake in a long beaded line (string-of-beads F-FDG uptake) or in a cluster (clustered F-FDG uptake) or focal F-FDG uptake. CT patterns included smooth uniform thickening, irregular thickening, or nodules. RESULTS More common findings in the parietal peritoneum corresponding to TBP as opposed to PC were (a) ≥4 involved regions (80.0% vs 19.6%), (b) uniform distribution (72.0% vs 5.9%), (c) string-of-beads F-FDG uptake (76.0% vs 7.8%), and (d) smooth uniform thickening (60.0% vs 7.8%) (all P < 0.001), whereas more frequent findings in PC compared with TBP were (a) SAPI distribution (78.4% vs 28.0%), (b) clustered F-FDG uptake (56.9% vs 20.0%), (c) focal F-FDG uptake (21.6% vs 4.0%), (d) irregular thickening (51.0% vs 12.0%), and (e) nodules (21.6% vs 4.0%) (P < 0.001, P < 0.05, P > 0.05, P < 0.05, P > 0.05, respectively). CONCLUSION Our data show that PET/CT findings in the parietal peritoneum are useful for differentiating between TBP and PC.
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Affiliation(s)
- Shao-Bo Wang
- PET/CT Center, the First People's Hospital of Yunnan Province, Kunming
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Yun-Hai Ji
- PET/CT Center, the First People's Hospital of Yunnan Province, Kunming
| | - Hu-Bing Wu
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Quan-Shi Wang
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Wen-Lan Zhou
- NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | | | - Tao Shou
- Department of Medical Oncology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Jing Hu
- Department of Medical Oncology, The First People's Hospital of Yunnan Province, Kunming, China
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15
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Fry DE. Extra-Pulmonary Tuberculosis and Its Surgical Treatment. Surg Infect (Larchmt) 2016; 17:394-401. [DOI: 10.1089/sur.2016.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Donald E. Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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16
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Chun J. A patient presenting with abdominal pain radiating to the back. Intest Res 2016; 14:289-91. [PMID: 27433153 PMCID: PMC4945535 DOI: 10.5217/ir.2016.14.3.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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17
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Cavalli Z, Ader F, Valour F, Saison J, Boussel L, Dumitrescu O, Perpoint T, Chidiac C, May T, Ferry T. Clinical Presentation, Diagnosis, and Bacterial Epidemiology of Peritoneal Tuberculosis in Two University Hospitals in France. Infect Dis Ther 2016; 5:193-9. [PMID: 27295189 PMCID: PMC4929092 DOI: 10.1007/s40121-016-0113-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction Diagnosis of peritoneal tuberculosis (pTB) is difficult, even in developed countries, where data are lacking. The aim of the present study was to describe the clinical presentation, diagnosis, and bacterial epidemiology of pTB in France over a 10-year period. Methods A retrospective study was conducted on pTB in two university hospitals in France, between January 2004 and December 2014. Results Among the 34 patients, 76.5% were migrants from areas of endemic tuberculosis (TB), mainly Africa. The main presentation (85.3%) was a checkup of ascites or suspicion of peritoneal carcinomatosis. On abdominal computed tomography, ascites was found in 90.6% and peritoneal thickening in 75%. Surgery was required for diagnosis in 58.8% of patients. Six of the patients who did not undergo surgery had ultrasound-guided peritoneal biopsy. Bacteriology was positive for ascites in only 58.1% of cases, for peritoneal biopsy in 73.3%, while granuloma was found in 95.5%. TB polymerase chain reaction (PCR) was positive in 25% of peritoneal biopsy. Mycobacterium bovis was isolated in 23.1% of cases and Mycobacterium tuberculosis in 76.9%. Isolates were fully susceptible (except M. bovis naturally resistant to pyrazinamide). Many (38%) belonged to the lineage T (genetic analysis by spoligotyping). Cure rate was high (76.5%), after a 6–9 months of anti-tuberculous therapy. Conclusion In developed countries, early diagnosis of pTB is still a challenge. Ultrasound-guided peritoneal biopsy may facilitate diagnosis. TB PCR can be useful on peritoneal biopsy. The lineage T was the most prevalent lineage, but more data are required to directly incriminate this lineage in the pathophysiology of pTB.
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Affiliation(s)
- Zoé Cavalli
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. .,Université Claude Bernard 1, Lyon, France.
| | - Florence Ader
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard 1, Lyon, France.,Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Florent Valour
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard 1, Lyon, France.,Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Julien Saison
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard 1, Lyon, France
| | - Loïc Boussel
- Université Claude Bernard 1, Lyon, France.,Service de Radiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Oana Dumitrescu
- Université Claude Bernard 1, Lyon, France.,Laboratoire de Bactériologie, Hôpital de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard 1, Lyon, France
| | - Christian Chidiac
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard 1, Lyon, France.,Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Thierry May
- Service de Maladies Infectieuses et Tropicales, Hôpital de Brabois, CHU de Nancy, Vandœuvre-lès-Nancy, France.,Université de Lorraine, Nancy, France
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard 1, Lyon, France.,Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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18
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Abelenda Alonso G, Fernández-Marcote EM, Martín-Crespo Posada D, Pérez González M, Martínez Albares JL. Lower gastrointestinal bleeding as a presentation of miliary tuberculosis. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:527-9. [PMID: 26545948 DOI: 10.1016/j.gastrohep.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/12/2015] [Accepted: 08/20/2015] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Marta Pérez González
- General & Gastrointestinal Surgery Service, Severo Ochoa University Hospital, Leganés, Madrid, Spain
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19
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Abdominal tuberculosis: utility of laparoscopy in the correct diagnosis. J Gastrointest Surg 2015; 19:981-3. [PMID: 25650164 DOI: 10.1007/s11605-015-2753-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/14/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Abdominal tuberculosis is one of the most prevalent form of extra-pulmonary disease, and the diagnosis is difficult because of non-specific clinical features. METHOD We presented a case of a Tunisian woman with cough, nausea, decreased appetite and pelvic-abdominal pain. CT scan showed peritoneal thickening, peritoneal tiny nodules and enlarged mesenteric lymph nodes ascitic fluid. Sputum analysis was negative. Abdominal paracentesis was performed, and no malignant cell was detected. The Ziehl staining revealed a negativity for acid-fast bacilli. RESULTS Diagnostic laparoscopy was performed. Biopsy specimens of peritoneum, liver, omentum and diaphragm showed omental epithelioid granulomas with a centrale caseous necrosis and Langhans giant cells. The patient received anti-tubercular treatment. CONCLUSIONS In case of suspicion of tuberculosis, when bacteriologic and cytologic analysis is negative, laparoscopy with biopsies is helpful for correct diagnosis and appropriate management.
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20
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Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis. Diagn Microbiol Infect Dis 2014; 79:102-7. [DOI: 10.1016/j.diagmicrobio.2013.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 04/22/2013] [Accepted: 12/15/2013] [Indexed: 12/13/2022]
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21
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Shen YC, Wang T, Chen L, Yang T, Wan C, Hu QJ, Wen FQ. Diagnostic accuracy of adenosine deaminase for tuberculous peritonitis: a meta-analysis. Arch Med Sci 2013; 9:601-7. [PMID: 24049517 PMCID: PMC3776182 DOI: 10.5114/aoms.2013.36904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/11/2013] [Accepted: 01/21/2013] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Tuberculous peritonitis remains a diagnostic challenge for clinicians. Many studies have investigated the usefulness of adenosine deaminase (ADA) in ascites for the diagnosis of tuberculous peritonitis; however, the overall diagnostic accuracy of ADA for tuberculous peritonitis remains unclear. The aim of the present meta-analysis was to determine the overall accuracy of ADA measurements in the diagnosis of tuberculous peritonitis. MATERIAL AND METHODS We performed a systematic search in PubMed and Embase to identify published studies that evaluated the diagnostic role of ADA for tuberculous peritonitis. Quality was assessed according to standardized Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity and other measures of accuracy of ADA assay in order to diagnose tuberculous peritonitis were pooled using random effects models. Summary receiver operating characteristic curve (SROC) was used to summarize overall test performance. RESULTS Sixteen studies met inclusion criteria for the present meta-analysis. The pooled sensitivity and specificity for diagnosing tuberculous peritonitis were 0.93 (95% CI: 0.89-0.95) and 0.96 (95% CI: 0.94-0.97), respectively. The positive likelihood ratio was 15.80 (95% CI: 10.87-22.95), negative likelihood ratio was 0.09 (95% CI: 0.05-0.16) and diagnostic odds ratio was 249.28 (95% CI: 113.11-549.39). The area under the SROC was 0.98. CONCLUSIONS Ascitic ADA determination is a relatively sensitive and specific test for the diagnosis of tuberculous peritonitis. Measurement of ADA in ascites is thus likely to be a useful diagnostic method for tuberculous peritonitis.
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Affiliation(s)
- Yong-Chun Shen
- Division of Medicine, West China Hospital of Sichuan University, Chengdu, P.R. China
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22
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Chen YX, Zeng CY, Shu X, Zhou XJ, Ma JH, Lv NH. Use of natural orifice translumenal endoscopic surgery in the diagnosis of suspected tuberculous peritonitis: a retrospective case series of 7 patients. J Laparoendosc Adv Surg Tech A 2013; 23:610-6. [PMID: 23808847 DOI: 10.1089/lap.2013.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In cases of ascites of unknown etiology, tuberculosis peritonitis (TBP) is a possible cause but a diagnostic challenge. This retrospective case series assessed the effectiveness and safety of diagnostic natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and the Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) in 7 consecutive patients with suspected TBP. SUBJECTS AND METHODS Between September 2011 and August 2012, peritoneal biopsy was performed using transgastric NOTES for subsequent histology in 7 consecutive hospitalized patients who presented with ascites and were diagnosed with suspected TBP. The outcome measures included diagnostic accuracy and procedure-related morbidities. RESULTS Diagnostic NOTES was successfully completed in all 7 patients. Peritoneoscopy with NOTES went uneventfully and lasted 5-10 minutes. Typical peritoneal nodules characteristic of TBP were identified in all patients and confirmed pathologically as TBP. No clinically significant adverse events occurred in any patients following NOTES, except for 1 patient who experienced mild and transient pyrexia. Postoperative blood culture detected no microbial growth. Follow-up upper gastrointestinal endoscopy showed that the gastric wall wound healed well with minimal scarring. All patients were prescribed a standard four-drug antituberculosis chemotherapy regimen. The treatment outcomes were determined to be effective or curative, and no relapse was detected within the follow-up period. CONCLUSIONS NOTES is an effective and safe diagnostic technique in patients with suspected TBP presenting as ascites of unknown etiology.
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Affiliation(s)
- You-Xiang Chen
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
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23
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Yang Y, Zhang W, Xu H, Lv H, Ma Z, Xue D. A Novel Approach: Transumbilical Endoscopic Exploration and Biopsy for Patients with Unknown Ascites. J Laparoendosc Adv Surg Tech A 2012; 22:691-4. [PMID: 22827612 DOI: 10.1089/lap.2012.0097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Youlin Yang
- Department of Gastroenterology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weihui Zhang
- Department of Minimally Invasive Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongyu Xu
- Department of Gastroenterology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hang Lv
- Department of Minimally Invasive Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhibin Ma
- Department of Gastroenterology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongbo Xue
- Department of Minimally Invasive Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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24
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Song HY, Wang B. Tuberculous peritonitis in patients from an underdeveloped region: A retrospective analysis of 40 cases. Shijie Huaren Xiaohua Zazhi 2012; 20:1998-2005. [DOI: 10.11569/wcjd.v20.i21.1998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the characteristics of tuberculous peritonitis in patients from an underdeveloped region.
METHODS: The clinical data for 40 patients with tuberculous peritonitis were analyzed to summarize the features of tuberculosis peritonitis in terms of its history, clinical manifestations, laboratory testing, auxiliary examination, diagnosis, and differential diagnosis.
RESULTS: In our series, tuberculous peritonitis was more common in patients between 20-40 years old (57.5%), and only 22.5% of patients had a previous history of tuberculosis or chronic diseases. Tuberculous peritonitis usually had a chronic onset (85%). Common manifestations were abdominal distention (85%), anorexia (67.5%), fever (52.5%), and abdominal pain (47.5%). The signs of ascites (67.5%) and abdominal tenderness (65%) were common. Serological tests had low specificity. Ascites was exudative. Ascites ADA > 33 U/L and monocyte predominance may contribute to the diagnosis of tuberculous peritonitis. The positive rates of ascites acid-fast bacillus smear and Mycobacterium tuberculosis culture were low (4.75% and 0%, respectively). The positive rate of PPD test and abnormal rate of chest X-ray were both 37.5%. The abnormal rate of abdominal CT and B-mode ultrasound scan were both 78%. The uterus and annexes were involved in 72.7% of female TBP patients. Five cases (12.5%) were misdiagnosed, of whom 3 were misdiagnosed as gynecologic tumors. Only 4 cases (10%) were confirmed by microbiology or pathology, and the remaining 36 cases (90%) relies on experimental anti-TB treatment to achieve the diagnosis.
CONCLUSION: In underdeveloped regions, the vast majority of tuberculous peritonitis cases are diagnosed by experimental anti-TB treatment due to the limited availability of laparoscopy or B ultrasound-guided biopsy.
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25
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Barberot-de Laubrière C, Chinellato-Joly S, Le Goudeveze S. Abdominal tuberculosis. J Visc Surg 2012; 149:e280-1. [PMID: 22633571 DOI: 10.1016/j.jviscsurg.2012.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C Barberot-de Laubrière
- Service d'imagerie médicale, hôpital d'instruction des Armées Clermont-Tonnerre, 29200 Brest, France.
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26
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Comparison Between Laparoscopy and Noninvasive Tests for the Diagnosis of Tuberculous Peritonitis: Reply. World J Surg 2012. [DOI: 10.1007/s00268-012-1467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Garg PK, Jain BK, Mohanty D. Tuberculous peritonitis: the closer you go, the more confused you get. World J Surg 2012; 36:1213-1214. [PMID: 22202995 DOI: 10.1007/s00268-011-1400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, 110095, India.
| | - Bhupendra Kumar Jain
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, 110095, India
| | - Debajyoti Mohanty
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, 110095, India
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28
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Ramana B. Comparison between laparoscopy and noninvasive tests for the diagnosis of tuberculous peritonitis. World J Surg 2011; 35:2376. [PMID: 21904989 DOI: 10.1007/s00268-011-1257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B Ramana
- Belle Vue Clinic, 9&10 Loudon Street, Kolkata, 700017, India.
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