European Journal of Gastroenterology & Hepatology

Accession Number<strong>00042737-200105000-00019</strong>.
AuthorDemir, Kadir a; Okten, Atilla a; Kaymakoglu, Sabahattin a; Dincer, Dinc a; Besisik, Fatih a; Cevikbas, Ugur b; Ozdil, Sadakat a; Bostas, Gungor a; Mungan, Zeynel a; Cakaloglu, Yilmaz a
Institution(a)Division of Gastroenterohepatology, Department of Internal Medicine, and (b)Department of Pathology, Istanbul Medical Faculty, Istanbul, Turkey
TitleTuberculous peritonitis - reports of 26 cases, detailing diagnostic and therapeutic problems.[Article]
SourceEuropean Journal of Gastroenterology & Hepatology. 13(5):581-585, May 2001.
AbstractObjective: To evaluate the clinical presentation, biochemical (ascites and serum) and laparoscopic findings, and to assess the efficacy of triple anti-tuberculous therapy without rifampicin for 6 months in patients with tuberculous peritonitis.

Methods: Twenty-six tuberculous peritonitis patients (11 male, 15 female) with a mean age of 34.8 +/- 3.4 years (range 14-77) were assessed with regard to diagnostic and therapeutic features.

Results: The most common symptoms and signs were abdominal pain (92.3%) and ascites (96.2%), respectively. Tuberculin skin test (TST) was positive in all patients. An abnormal chest radiography suggestive of previous tuberculosis was present in five patients (19.2%), and two patients (7.7%) had extra-peritoneal (cerebral, pericardial) active tuberculous involvement. In 24 of the 25 patients who underwent laparoscopy with directed biopsy, whitish nodules suggested tuberculous peritonitis; 76% of the biopsy specimens revealed caseating, 20% non-caseating granulomatous inflammation, and 4% non-specific findings. The ascitic fluid of one patient (3.8%) was positive for acid-resistant bacilli, and culture was positive in two patients (7.7%). Twenty-four of the patients were treated for 6 months with isoniazid, streptomycin (total dose 40 g) and pyrazinamide (for the first 2 months and then substituted with ethambutol). Eighteen patients also received methyl prednisolone, initially 20 mg/day, for 1 month. The follow-up period was 19 +/- 1.7 months after the end of therapy (range 6-36). Ascites and abdominal pain abated earlier in patients on steroid therapy. All but two of the 24 patients responded to treatment.

Conclusion: Non-invasive tests such as acid-fast stain and culture of the ascitic fluid are usually insufficient, hence invasive laparoscopy and peritoneal biopsy are necessary for the diagnosis of tuberculous peritonitis if non-invasive tests such as ascites adenosine deaminase activity measurement are not easily available. Triple therapy without rifampicin for 6 months is sufficient to treat tuberculous peritonitis.

(C) 2001 Lippincott Williams & Wilkins, Inc.