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Essobiyou TB, Labou AK, Sakiye KA, Alassani F, Tchangai B. The place of presumptive diagnosis in the management of peritoneal tuberculosis: A case report from rural Togo. Int J Surg Case Rep 2023; 110:108655. [PMID: 37591195 PMCID: PMC10457525 DOI: 10.1016/j.ijscr.2023.108655] [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: 07/17/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Tuberculosis is a major public health problem in developing countries. Its main abdominal form is peritoneal. The diagnosis of this peritoneal form is complex and difficult. We describe the role of presumptive diagnosis in the management of this condition in Togo, based on a case study. CASE PRESENTATION A security guard with no previous pathological history was seen in consultation with febrile ascites. Investigations revealed the exudative and lymphocytic nature of the ascites. The other investigations did not reveal any other organic lesion, particularly hepatic, or the germ. This typical ascites picture had for us a strong diagnostic value in favour of a tubercular origin. The patient was treated with antituberculosis drugs for 6 months. The evolution was satisfactory. CLINICAL DISCUSSION The diagnosis of peritoneal tuberculosis is difficult. Biological explorations are rather disappointing in this approach. Laparoscopy coupled with histological examination represents the best means of diagnosing peritoneal tuberculosis to date. However, in developing countries, the absence of these resources poses a real problem. Clinical and biological arguments are always at the forefront of the diagnosis in endemic countries. The latter is based on the demonstration of febrile, exudative and lymphocytic ascites. CONCLUSION The difficult diagnosis of peritoneal tuberculosis coupled with the lack of technical facilities gives the presumptive diagnosis an important place in the management of this condition in endemic countries.
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Affiliation(s)
- Tamassi Bertrand Essobiyou
- General Surgery Department, Dapaong Regional Hospital Center, Dapaong, Togo; General Surgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo.
| | - Albert Kossi Labou
- Neurosurgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo
| | | | - Fousseni Alassani
- Visceral Surgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo
| | - Boyodi Tchangai
- Visceral Surgery Department, Sylvanus Olympio University Hospital Center, Lome, Togo
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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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Mbengue A, Ndiaye AR, Amar NI, Diallo M, Diack A, Ndao MD, Diop M, Fall A, Diouf CT, Soko TO, Diakhate IC. Ultrasonography of peritoneal tuberculosis. J Ultrason 2019; 19:98-104. [PMID: 31355580 PMCID: PMC6750313 DOI: 10.15557/jou.2019.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose The objective of this work was to describe different presentations of peritoneal tuberculosis on ultrasound. Materials and methods This was a retrospective study conducted between 2008 and 2016 at the Main Hospital in Dakar, and including 38 cases of peritoneal tuberculosis. The tests were performed on Philips Envisor and Hitachi Preirus with 10 and 12 MHz linear transducers. The mean age was 26 years and the sex ratio was 0.8. The diagnosis of peritoneal tuberculosis was based on histological evidence (17 cases), isolation of BK from sputum (5 cases), positive adenosine deaminase in ascites fluid (4 cases) or a favorable clinical course after trial antituberculosis treatment (4 cases). The structures studied were the parietal peritoneum, the mesentery, the large omentum, as well as the characteristics of ascites, and extra-peritoneal lesions. Results Parietal peritoneal involvement was found in 89.4% of patients, including regular diffuse hypoechoic thickening in 70.5% and nodular thickening in 11.7%. Ascites was present in 84.2% of patients. The great omentum showed anomalies in 73.6% of cases in relation to 3 aspects: trilamellar thickening made up of a thick, hyperechoic central layer surrounded by 2 thin peripheral hypoechoic layers in 46.4% of cases; a single-layer hyperechoic thickening in 21.4% of cases; heterogeneous hyperechogenic thickening with hypoechoic nodules in 32.1% of cases. Mesentery abnormalities were noted in 63.1% of patients with hypoechoic thickening. Conclusion Ultrasound with the advantage of safety and accessibility is a reliable technique for the diagnosis of peritoneal tuberculosis. In some cases, it allows for a guided percutaneous biopsy to avoid the use of laparoscopy.
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Affiliation(s)
- Ababacar Mbengue
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | | | - Ndeye Isseu Amar
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Moustapha Diallo
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Aminata Diack
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Mame Diarra Ndao
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Massamba Diop
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | - Amath Fall
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
| | | | - Thierno Omar Soko
- Département d'Imagerie Médicale Hôpital Principal de Dakar , Dakar , Sénégal
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[Analysis of a series of 44 cases of peritoneal tuberculosis diagnosed in the pathology laboratory of the Tokoin teaching hospital of Lomé (1993-2014)]. ACTA ACUST UNITED AC 2015; 108:324-7. [PMID: 26608272 DOI: 10.1007/s13149-015-0458-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
Abstract
It is a descriptive and cross-sectional study on all issues relating to peritoneal tuberculosis histological diagnosed in the pathology department (LAP) of the Lomé Tokoin CHU from January 1993 to December 2014 (20 years). A total of 44 cases of peritoneal tuberculosis were included. They were 18 women and 26 men, with a mean age of 37.6±0.2 years. The circumstances of discovery were dominated by ascites (84.1%), fever (75%), weight loss (63.6%) and abdominal pain (59.1%). The peritoneal involvement was isolated in 31.8% of cases, and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was present in 63.9% of cases. Twenty-five patients (69.4%) with information about their social conditions had low socioeconomic level: unemployed (10 cases; 40%), workers (10 cases; 40%) and retired (5 cases; 20%). An increase in cell count was observed in 94.6% of cases. Histology revealed the epithelial giant cell granuloma associated with caseous necrosis in 38 cases (86.4%) and cheesy isolated in 6 patients. Peritoneal tuberculosis is not exceptional in our country. The diagnosis should be considered in febrile ascites, and will be confirmed by laparoscopy with histological samples for a histological diagnosis.
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Abstract
Invasive peritoneal disease includes more than just peritoneal carcinomatosis. Although this is the most common aetiology, especially when a primary is found, other conditions may be responsible for peritoneal invasion. A rigorous analysis of CT features taken together with the clinical and biological context usually allows the main differential diagnoses, which entail different types of management, to be drawn out. Pseudomyxoma peritonei, peritoneal lymphomatosis, tuberculosis, peritoneal mesothelioma, diffuse peritoneal leiomyomatosis, and benign splenosis are the main differential diagnoses.
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An Exceptional Association of Genital Cancer and Peritoneal Tuberculosis: 1 Case and a Literature Review. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tuberculose abdominale : étude rétrospective de 90 cas. Rev Med Interne 2011; 32:212-7. [DOI: 10.1016/j.revmed.2010.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 08/16/2010] [Accepted: 09/19/2010] [Indexed: 11/18/2022]
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Guirat A, Koubaa M, Mzali R, Abid B, Ellouz S, Affes N, Ben Jemaa M, Frikha F, Ben Amar M, Beyrouti MI. Peritoneal tuberculosis. Clin Res Hepatol Gastroenterol 2011; 35:60-9. [PMID: 21215540 DOI: 10.1016/j.gcb.2010.07.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/27/2010] [Accepted: 07/19/2010] [Indexed: 02/04/2023]
Abstract
The peritoneum is one of the locations outside the most common pulmonary tuberculosis. Peritoneal tuberculosis poses a public health problem in endemic regions of the world. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease in regions where it was previously controlled. The aim of this review is to expose the clinical, biologic end radiologic futures of the peritoneal tuberculosis and to present the methods of diagnosis and treatment. The diagnosis of this disease is difficult and still remains a challenge because of its insidious nature, the variability of presentation and limitations of available diagnostic tests. The disease usually presents a picture of lymphocytic exudative ascites. There are many complementary tests with variable sensitivities and specificities to confirm the diagnosis of peritoneal tuberculosis. Isolation of mycobacteria by culture of ascitic fluid or histological examination of peritoneal biopsy ideally performed by laparoscopy remains the investigation of choice. The role of PCR, ascitic adenosine deaminase, interferon gamma and the radiometric BACTEC system can improve the diagnostic yield. An antituberculous treatment with group 1 of the WHO for 6 months is sufficient in most cases.
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Affiliation(s)
- A Guirat
- Service de chirurgie générale, CHU Habib Bourguiba, 3029 Sfax, Tunisia.
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Capron J, Lafont C, Grateau G, Steichen O. Diagnostic non invasif d’une tuberculose péritonéale. Rev Med Interne 2010; 31:e10-1. [DOI: 10.1016/j.revmed.2009.10.441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 09/14/2009] [Accepted: 10/03/2009] [Indexed: 11/25/2022]
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Barbagallo F, Latteri S, Sofia M, Ricotta A, Castello G, Chisari A, Randazzo V, Greca GL. Appendicular tuberculosis: The resurgence of an old disease with difficult diagnosis. World J Gastroenterol 2010; 16:518-21. [PMID: 20101782 PMCID: PMC2811809 DOI: 10.3748/wjg.v16.i4.518] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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
Gastrointestinal tuberculosis (TB) is quite rare, representing only 3% of all extra-pulmonary cases. Blind gut and ileum are the most common gastrointestinal localizations, while appendix involvement is infrequent. Appendix involvement is usually related to symptoms of acute appendicitis since the caseous necrosis may lead to adhesions and surgical complications such as perforation. For this reason patients with suspected appendicular TB usually undergo surgery even without a secure diagnosis. In these cases, due to the absence of specific symptoms and signs, the diagnosis is delayed after surgery, thus resulting in a high percentage of important, and sometimes lethal, complications. Histopathological examination is often the only way to reach a diagnosis and to establish specific antibiotic therapy, while an early diagnosis could avoid surgical treatment. We report a case of appendicular TB not only for its rarity but also to discuss the difficulty in its diagnosis.
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Abstract
PURPOSE OF REVIEW Intestinal tuberculosis (TB) is increasing due partly to the HIV pandemic. Its clinical presentation mimics inflammatory conditions such as Crohn's disease and malignancies, which are becoming more prevalent, so the diagnosis is problematic. RECENT FINDINGS Greater awareness of intestinal TB is needed, both in countries where TB is endemic and developed countries with immigrant populations. Some strains of Mycobacterium tuberculosis are associated with more extrapulmonary disease and greater dissemination, thereby exacerbating the rise in HIV-associated extrathoracic TB. Recent retrospective and prospective studies are leading to the development of diagnostic algorithms. A wide range of imaging techniques is available for sampling and diagnosis. New biochemical, immunological and molecular diagnostic methods are being developed but must be standardized and validated. Developments in drug delivery will facilitate oral therapy even in patients suffering from malabsorption. SUMMARY There is an increasing consensus on the risk factors and clinical presentations of intestinal TB. Imaging techniques, coupled with fine needle biopsies, are useful aids to diagnosis, but most important is a greater awareness of the condition by clinicians.
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Affiliation(s)
- Helen D Donoghue
- Centre for Infectious Diseases and International Health, Department of Infection, University College London, London, UK.
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