Peritoneal tuberculosis

Authors K. Mimidis, K. Ritis, G. Kartalis.


Tuberculosis (TB) can involve any part of the gastrointestinal
tract and is the sixth most frequent site of extrapulmonary
involvement. Both the incidence and severity of
abdominal tuberculosis (AT) are expected to increase with
increasing incidence of HIV infection. Peritoneal tuberculosis
(PT), a form of AT, occurs in three forms: wet type
with ascites, dry type with adhesions, and fibrotic type with
omental thickening and loculated ascites. Clinically, PT is
characterized by fever, abdominal pain, anorexia, weight
loss, and ascites. However, none of these symptoms is specific
for the disease, so it is commonly misdiagnosed, especially
as carcinomatous peritonitis in the elderly. Early diagnosis
of PT is of major importance in the control of the
disease. Chest X-rays show evidence of concomitant pulmonary
lesions in less than 25 per cent of cases. Laparoscopy
with direct biopsy is an excellent diagnostic method
and must be considered for every patient with unexplained
ascites. A definitive diagnosis requires identification of
bacilli in ascitic fluid or peritoneum tissue. However, acidfast
staining is usually negative and cultures are positive
in 30-40% of cases, making bacteriological confirmation of
the disease very difficult. Recently, advances in molecular
techniques have provided a new approach to the rapid diagnosis
of tuberculosis by nucleic acid probes and polymerase
chain reaction (PCR). Management is with conventional
antitubercular therapy for at least six months.
Key words: PCR, ascites, peritoneal tuberculosis