Differentiation of Tuberculous Peritonitis from Peritonitis Carcinomatosa without Surgical Intervention

Background/Aim:

Ascites of tuberculous peritonitis (TBP) is an exudative type and may well be misdiagnosed as carcinomatous peritonitis, especially in the elderly. The aim of this study was to identify independent predictors that can differentiate TBP from peritonitis carcinomatosa without surgical intervention.

Patients and Methods:

This prospective cohort study was performed on 75 subjects in the following groups: TBP (n=27) (TBP group), ovarian cancer complicated with ascites (n=24) (Ov Ca group), and gastric cancer complicated with ascites (n=24) (Ga Ca group). The frequency of clinical symptoms, laboratory parameters, and serum tumor markers levels were compared.

Results:

In univariate analysis; fever, night sweats, and abdominal pain were significantly more frequent in the TBP group compared to those in the Ov Ca group (P < 0.001, P < 0.001, and P = 0.035, respectively) and the Ga Ca group (P < 0.001, P < 0.001, and P = 0.015, respectively). Serum CA 19-9 and carcino embryonic antigen (CEA) levels were significantly lower in the TBP and Ov Ca group compared to the Ga Ca group (P < 0.001 and P < 0.001, respectively). Elevated serum CA 125 level was found in all patients with TBP and Ov Ca and in 86.6% of patients with Ga Ca. In the multivariate analysis, presence of fever (P < 0.001), night sweats (P < 0.001), age under 40 years (P = 0.008), and normal serum CA 19-9 level (P = 0.044) were independent predictor of diagnosis of TBP.

Conclusion:

The presence of fever, elevated serum CA 125 level, normal serum CA 19-9, and CEA associated with lymphocyte predominant benign ascites may establish the diagnosis of TBP.     

Tuberculous Peritonitis

Five Vietnamese patients with tuberculous peritonitis are described. Fever, x-ray evidence of pulmonary tuberculosis, or positive PPD skin tests were absent in several patients. The diagnosis was considered only when routine paracentesis demonstrated ascitic fluids with increased protein concentrations and lymphocytic pleocytosis. Ascitic fluid glucose concentrations were less than 30 mg./100 cc. in three of five patients.     

Tuberculous Peritonitis

A 32-year old Dominican woman with signs and symptoms of an acute abdomen, was found to have tuberculous peritonitis. Our experience with this is presented along with a review of the literature.
Population shifts may bring about an increased number of cases in this country. Awareness of this entity will avoid unnecessary diagnostic errors and laparotomy. The surgeon should also be versed in the total management and be prepared to handle the surgical complications of the disease.     

Gallium-67-citrate Scanning in Tuberculous Peritonitis

A 32-year old black, alcoholic male was noted to have an abnormal Gallium-67-citrate scan during a work-up for persistent fever. Surgical biopsies revealed findings of the dry form of tuberculosis peritonitis. The literature concerning Gallium-67-citrate scanning was reviewed and its usefulness in inflammatory disease states (including two reports of positive scans in tuberculous peritonitis) was demonstrated. In addition, we have considered the possible mechanisms of Gallium-67-citrate uptake by inflammatory cells and its probable relationship to the granulomas associated with tuberculous peritonitis. We conclude that Gallium-67-citrate scanning is an important diagnostic procedure in the evaluation of a fever of unknown origin. Moreover, it may significantly shorten the diagnostic work-up of those cases of tuberculous peritonitis.     

126例结核性腹膜炎临床分析

目的分析结核性腹膜炎的临床特点,探讨其诊断和治疗方法。方法分析2002年3月~2009年1月我院确诊126例结核性腹膜炎患者的临床特点。结果各项检查的阳性率分别为血沉增快79.3%（100/126）,PPD阳性62.2%（74/119）,血结核抗体39.7（50/126）,腹部B超78.6%（99/126）,腹部CT 48.7（38/78）,胸部X线片40.5%（51/126）,腹水腺苷酸脱氨酶（ADA）活性增高73.9（34/46）,腹腔镜检查阳性88.9%（16/18）,腹膜活检100%（6/6）,通过各项诊断方法及时诊断,合理用药,治疗总有效率达80.15%。结论联合不同诊断方法,正确诊断,联合长期用药,必要时配以手术治疗,可提高结核性腹膜炎的临床诊治水平。     

54例结核性腹膜炎临床分析

目前医疗条件普遍较好，但结核性腹膜炎的误诊率仍较高。目的：通过分析结核性腹膜炎的临床特点，探讨其实用诊断方法。方法：回顾性分析2002年1月-2007年8月安徽省计划生育学校附属医院确诊的54例结核性腹膜炎患者的临床特点。结果：结核性腹膜炎的误诊率为27．8％，各项辅助检查的阳性率分别为血常规异常37．0％（20／54），血细胞沉降率增快75．9％（41／54），结核菌素试验阳性63．0％（34／54），抗结核抗体阳性48．1％（26／54），血清转铁蛋白下降85．2％（46／54）．腹水腺苷脱氨酶（ADA）活性增高59．1％（13／22），胃镜检查阳性56．2％（9／16），腹腔镜检查阳性87．5％（7／8）。结论：腹腔镜检查和血清转铁蛋白对结核性腹膜炎的诊断阳性率最高，但前者有创伤性，后者缺乏特异性。血清转铁蛋白检测可能为结核性腹膜炎的临床诊断提供了一种新方法。应结合患者的临床表现、各项辅助检查和抗结核治疗的疗效诊断结核性腹膜炎。     

小口径腹腔镜检查对结核性腹膜炎的诊断价值：21例临床分析

背景：结核性腹膜炎临床表现常不典型，误诊、漏诊率较高。目的：探讨小口径腹腔镜检查对结核性腹膜炎的诊断价值和安全性。方法：回顾性分析2006年1月～2007年12月于复旦大学附属中山医院行小口径腹腔镜检查，最终诊断为结核性腹膜炎的21例患者的一般情况、腹腔镜表现和实验室、辅助检查结果。结果：1例患者因腹腔严重黏连而终止检查；20例（95．2％）腹腔镜直视可见腹腔内弥漫粟粒样结节，结合临床表现诊断为结核性腹膜炎，其中17例（81．0％）取得活检组织，经病理检查明确诊断。21例患者中，渗出型11例（52．4％），黏连型7例（33．3％），干酪型3例（14.3％）。术后并发症发生率为9．5％，包括穿刺部位出血和皮下气肿各1例。小口径腹腔镜直视诊断阳性率显著高于结核菌素纯蛋白衍生物（PPD）试验、腹水乳酸脱氢酶（LDH）、血清和腹水肿瘤相关糖链抗原125（CA125）、腹水腺苷脱氨酶（ADA）检测等（P〈0．05）。结论：小口径腹腔镜检查用于诊断结核性腹膜炎，操作简便、安全，诊断准确性高。     

Amebic Peritonitis

A total of 18 patients with amebic peritonitis were studied. Fourteen of these cases were due to rupture of amebic liver abscess into the peritoneum and the remaining cases were due to perforation of amebic colitis. No initial suspicion of amebic etiology was made in more than half of the cases. In the group of ruptured liver abscesses, nearly half of the patients showed right lower lung syndrome. The diagnosis in 13 of 14 cases of rupture of liver abscess was confirmed on aspiration.
Patients with ruptured amebic liver abscess were of two types: 1. Diffuse type with diffuse signs, shorter duration of illness and poor prognosis. 2. Localized type with longer duration of illness, marked signs of peritonitis and better prognosis.     

Barium Peritonitis

A case of generalized peritonitis, secondary to a rupture of the rectosigmoid portion of the colon is presented. The surgical management is discussed, a basic part of which is the use of a Baker tube to splint the small intestine while adhesions form in a pattern along the tube, as a substitute method for a Nobel plication, to prevent chronic small intestinal obstruction. Extensive lavage of the peritoneal cavity should also be carried out. Energetic fluid replacement with careful monitoring of the fluid and electrolyte balance is essential before, during and after the surgical procedure. Adequate broad spectrum antibiotic coverage is important. We believe that the management of these cases should be by surgical intervention and institution of the above mentioned measures and not by expectant therapy and treatment of complications.     

PD-assoziierte Peritonitis

Peritoneal dialysis (PD) is an accepted alternative in the treatment of endstage renal disease patients. PD has many advantages, especially for patients waiting for a kidney allograft, such as better preservation of residual renal function and earlier primary functioning of the kidney allograft. It is associated with a higher flexibility and better quality of life. The rate of peritonitis is now very much less than in earlier decades, and in experienced centres is less than one case in 60 patient treatment months. It is important that preventive strategies as well as diagnostic and therapeutic procedures are standardized and updated every few years by the International Society of Peritoneal Dialysis.     

Peritonitis.

Intraperitoneal infections or inflammatory disease in elderly patients are a diagnostic challenge that will be encountered with increasing frequency in the aging population of the United States. Diagnostic clues are not overt and frequently appear late in the course of the disease. Confusion and subtle changes in clinical status are important signals. A high index of suspicion is required to initiate diagnostic procedures. Therapy will frequently be modified not only to the disease process but also to the patient to incorporate concepts of minimally invasive procedures. The advent of laparoscopic surgery may be a great advance in the diagnosis and treatment of intra-abdominal crisis in geriatric patients. It also may make elective surgery conform more to the goals of the geriatric patient and thus prevent the high morbidity and mortality associated with emergency surgery in this age group.     

Post-Sclerotherapy Bacterial Peritonitis

Endoscopic variceal sclerotherapy has been associated with a number of complications. Peritonitis after sclerotherapy has rarely been reported. In this retrospective review of 213 consecutive sclerotherapy procedures among 65 patients over a 3-yr period, we found that six cases of peritonitis occurred, for an incidence of approximately 3%. All patients developing post-sclerotherapy peritonitis had low ascitic fluid protein. However, this did not differ from patients who did not develop peritonitis. No patient on antibiotics at the time of sclerotherapy developed peritonitis. Peritonitis should be considered in the diagnosis of post-sclerotherapy fever. The role of prophylactic antibiotics to prevent this complication is uncertain.     

Listeria Monocytogenes Peritonitis

Listeria monocytogenes peritonitis in a patient with cirrhosis and simultaneous soft tissue infection is reported. Six previously documented cases are reviewed. All seven patients were bacteremic, suggesting hematogenous seeding to the peritoneum as the pathogenic mechanism. Clinical and laboratory characteristics of L. monocytogenes peritonitis are compared with peritonitis of other bacterial etiologies.     

Spontane bakterielle Peritonitis

Zum Thema Die bakterielle Fehlbesiedelung des oberen Dünndarms, die bei Leberzirrhose h?ufig anzutreffen ist und zu der Aszites geradezu pr?disponiert, dürfte zum Entstehen der spontanen bakteriellen Peritonitis (SBP) wesentlich beitragen. Mangelern?hrung, St?rungen der unspezifischen und spezifischen regionalen Abwehr spielen dabei ebenfalls eine wichtige Rolle. Bemerkenswert erscheint die nachgewiesene Erh?hung von Interleukin-6 und anderen Makrophagen-assoziierten Zytokinen in der der Aszitesflüssigkeit. Das Krankheitsbild der SBP wird in dieser übersicht eingehend unter den Gesichtspunkten der Epidemiologie, Klinik, Risikofaktoren, Pathogenese, Diagnostik, Prognose, Therapie sowie Rezidiv- und Prim?rprophylaxe abgehandelt. Neben einer umfassenden Literaturübersicht stützen sich die Verfasser auch auf Untersuchungen ihres eigenen umfangreichen Krankengut. Am Beispiel der SBP sei wieder einmal daran erinnert, da? eine Komplikation, hier als eine Peritonitis bei Aszites, zwar lange bekannt sein kann, als Krankheitsentit?t aber viel sp?ter erkannt und ausführlich beschrieben wird. Das trifft auf die SBP zu. So steht zu erwarten, da? das Krankheitsbild der spontanen bakteriellen Peritonitis für manche unserer nicht spezialisierten Leser ganz einfach noch nicht in das ?rztliche Gesichtsfeld getreten, also schlicht gesagt: neu ist.