Perforations digestives traumatiques : aspects anatomo-cliniques

Aims

To describe epidemiological and clinicopathological aspects of digestive traumatic perforations.

Materials and methods

This is a retrospective study of 9 years (January 1997 to December 2005) with a follow up of patients over 5 years. We were interested in the patients admitted to the surgical emergency unit of Aristide Le Dantec Hospital in Dakar for abdominal trauma with a digestive tract wound. All patients had undergone surgery which allowed confirmation of the gastrointestinal perforation.We studied the mechanism of injury, the circumstances of onset, the clinical presentation, the results of imaging and the location of the gastrointestinal lesion.

Results

There were 55 patients, all males. The average age was 27 years. The mechanism was closed abdominal trauma in 21.8% of cases (n = 12) and open abdominal trauma in 78.2% of cases (n = 43). The circumstances of occurrence were brawls in 58.2% of cases (n = 32). The acute generalized peritonitis was predominating. Radiography of the abdomen without preparation showed pneumoperitoneum in a third of cases. The small intestine was the segment the most affected. A lesion from another intra-abdominal organ existed in 20% of cases (n = 11).

Conclusion

Traumatic bowel injuries occur more often in open injuries of the abdomen and the small intestine is the most wounded segment.     

Diagnostic dilemma of abdominopelvic tuberculosis:a series of 20 cases

Objective

To establish more effective diagnostic procedures to identify the characteristic features of abdominopelvic tuberculosis (APTB) mimicking advanced ovarian cancer.

Methods

A retrospective review of 20 cases of APTB mimicking advanced ovarian cancer was undertaken.

Results

The mean age of the patients was 28.9 ± 10.8 years. The main clinical manifestations were abdominal pain (45%) and distention (45%). CA125 level was elevated in 18 cases (90.0%). Pelvic mass in 18 patients (90.0%) and ascites in 12 patients (60.0%) were detected by using abdominal US. The bacteriologic cultures and cytological studies were all negative (10 cases, 100%). Laparotomy (17 cases) and laparoscopic evaluation (1 case) was performed with the presumptive diagnosis of advanced ovarian cancer except for 2 patients treated with diagnostic anti-TB chemotherapy. The common intra-operative findings were miliary nodules (14 cases, 77.8%) and widespread adhesion (10 cases, 55.6%). Intra-operative frozen section was obtained in 10 cases, and the typical tuberculosis tubercles were detected in all cases.

Conclusion

APTB should be considered in all cases with pelvic mass, ascites and high levels of CA125, although clinical features and laboratory results specifically indicate neither ovarian malignancy nor APTB. Diagnostic laparotomy is a direct and safe method. To avoid extended surgery, the cases with APTB can be diagnosed through intra-operative frozen section in conjunction with clinical features.     

Funktionelle MRT im Abdomen

Background

Recently introduced magnetic resonance imaging (MRI) techniques based on diffusion-weighted imaging (DWI) allow molecular imaging of the free movement of water within the abdomen. The application of this new imaging method in the abdomen reveals a new perspective of abdominal imaging with a broadened scope of new clinical questions and answers.

Objectives

To determine new indications and answers for DWI in the classical problems in gastroenterology.

Material and methods

Review article focusing on functional DWI in all relevant gastrointestinal organs and structures and a brief discussion on important current studies on the topic.

Results

The DWI technique has a high potential for depicting inflammation particularly of the small bowel and colon without the use of intravenous contrast media. The use of MRI DWI in the diagnostics of the pancreas and liver allows improved differential diagnosis and detection as a supplementary investigation to conventional MRI techniques.

Conclusions

In the coming years there is an extremely high potential for DWI to greatly improve the diagnostic accuracy of the gastrointestinal tract and parenchymal abdominal organs. Because this technique has only recently been slowly incorporated into the routine procedures more prospective studies are urgently needed. Currently, there are great expectations especially regarding the detection of inflammation.     

La tuberculose hépatique : à propos d’un cas de présentation échographique exceptionnelle

Objective

To report a rare case of extrapulmonary tuberculosis (hepatic tuberculosis) and demonstrate the role of the ultrasound in its early detection, its precise diagnosis and in the monitoring of its treatment.

Method

We performed an abdominal ultrasound to a 12-year-old, immuno-competent teenager, complaining about chronic abdominal pain evolving for 8 months, without any notion of tuberculous contagium and presenting signs of tuberculous impregnation. The ultrasound examination was performed by means of an echo-doppler ultrasound device (Logic 400) of General Electric, provided with 2 probes (3.5 MHz and 7.5 MHz).

Results

The abdominal ultrasound found, a multi-micronodular hepatomegaly. Micronodules were homogeneous hypoechogenics, measuring between 3 and 4 mm in diameter and were spread in all the hepatic parenchyma. An ascites located in the pelvis was objectivized. There were neither adenopathies nor peritoneal nodules. The diagnosis of hepatic tuberculosis was evoked and confirmed by a hepatic punch-biopsy under ultrasound guidance. The patient was treated and a monthly ultrasound monitoring was performed. The disappearance of nodules and the ascites was obtained at the end of the 4th month of the treatment. That of the hepatomegaly is obtained one month later.

Conclusion

Ultrasound examination plays a very important role in the early detection of the hepatic tuberculosis, its precise diagnosis and the surveillance of the treatment. During its realization in a context of chronic abdominal pain at the child, the diagnosis of hepatic tuberculosis should be evoked in front of a multi-micronodular hepatomegaly, even at the immuno-competent child.     

A case of rapidly progressive IgA nephropathy in a patient with exacerbation of Crohn’s disease

Background

The inevitable post-inflammatory fibrosis and adhesion often compromises future treatment in peritoneal dialysis patients. Here, we describe a patient who experienced an unusual form of peritoneal adhesion that made her give up peritoneal dialysis. However, its unique pattern also saved her from infection caused by bowel perforation.

Case presentation

The female patient discontinued peritoneal dialysis due to gradual dialysis inadequacy. Two months after shifting to hemodialysis with generally improved sense of well-being and no sign of abdominal illness, she was admitted to remove the Tenckhoff catheter. The procedure was smooth, but fever and abdominal pain not at the site of operation developed the next day. Abdominal ultrasound showed the presence of ascites and aspiration revealed slimy, green-yellowish pus that gave a negative result on bacterial culture. Abdominal computed tomography (CT) with oral contrast medium was performed, but failed to demonstrate the suspected bowel perforation. The examination, however, did show accumulation of pus inside the abdomen but outside the peritoneal cavity. We drained the pus with two 14-F Pig-tail catheters and the total amount of drainage approached 4000 ml. The second CT was performed with double dose of the contrast medium and found a leak of the contrast from the jejunum. She then received laparotomy and had the perforation site closed.

Conclusions

In summary, this uremic patient suffered from pus accumulation inside her abdomen without obvious systemic toxic effect. The bowel perforation and pus formation might be caused by repeated peritonitis, but the peritoneal adhesion itself might also isolate her peritoneal cavity from the anticipated toxic injuries of bowel perforation.     

Diagnostische Optionen

Background

A variety of diagnostic methods provide the necessary rational basis for diagnosis, assessment of disease activity and exclusion of possible complications for patients with inflammatory bowel disease (IBD).

Aim

Currently, a wide range of diagnostic methods is available and easily accessible. The clinical use of all these different methods is inherently possible. As there is no reference test for either diagnosis or monitoring of IBD, diagnostic techniques must be selected, applied and interpreted in an appropriate clinical context. The objective is to evaluate the clinical, laboratory and imaging techniques including ultrasound and endoscopy in different clinical situations.

Results

In addition to clinical parameters, fecal calprotectin and abdominal ultrasound are helpful tools to assess the inflammatory activity. In patients with high inflammatory activity, a routine endoscopy is not beneficial. At best, endoscopy can be performed to document the extent of mucosal inflammation before initiating an intensified immunosuppressive therapy. Knowledge and experience in the management and treatment of IBD complications are critical in providing a rational use of specific diagnostic methods.

Conclusion

As a basic principle, the critical evaluation of diagnostic methods in patients with IBD is of great importance. Specific clinical situations require specific diagnostic techniques. Every diagnostic method performed should have a purpose.     

Lymphangiome kystique de l’abdomen chez l’adulte. Une tumeur très polymorphe

Aim

Describe the clinical polymorphism and diagnostic and therapeutic difficulties related to abdominal cystic lymphangioma in the adult.

Material and methods

Six cases of abdominal cystic lymphangioma, treated between 2000 and 2008, were retrospectively analysed. Were included only those patients with post-operative histological confirmation of the diagnosis.

Results

Three men and three women were operated on, ranging in age from 32 to 56 years (mean age 43 years). Symptoms were: abdominal pain in five cases, abdominal mass in three cases, intestinal obstruction in one case, one case of ascites, inferior member oedema in one case and a chance discovery in one case. Tumours were mesenteric in two cases, retroperitoneal in two cases, once in the spleen and once in the right adrenal gland. The size of the tumours varied between 50 and 450 mm. Complete resection was performed in all cases, requiring segmental resection of the intestine in one case, one splenectomy and one right adrenalectomy. After an average follow-up of four years, one retroperitoneal recurrence was noted.

Conclusion

Abdominal cystic lymphangioma in the adult present a very difficult diagnostic challenge and the correct diagnosis often remains elusive until tissue is obtained. The treatment of choice is complete surgical resection, although it does not always prevent local recurrence.     

Treating symptomatic adhesions to the sigmoid colon: colectomy improves quality of life

Introduction

When severe chronic pelvic pain, constipation, and bloating are due to dense pelvic adhesions fixing the sigmoid loops, patients may be offered the option of sigmoid colectomy. This study examines the effectiveness of colectomy in the treatment of such patients.

Methods

Patients were identified from a surgical database, demographic data were abstracted, and charts were reviewed. Patients were interviewed postoperatively. Primary end points were morbidity, length of stay, change in bowel habit, and patient satisfaction.

Results

There were 46 patients (44 women) with a mean age of 54.7 years (±14.3). Forty-three had a history of prior pelvic surgery (93 %), including 30 (65 %) with hysterectomy. One quarter had been diagnosed with irritable bowel syndrome. Surgery revealed adhesive tethering of the sigmoid colon in 43 patients (94 %). Mean length of stay was 6.5 days (±2.5), and complications occurred in eight (17.3 %) patients. There were no deaths, and no patients required a stoma. Follow-up in 37 patients after mean of 7.2(±5.0)?years showed significant reductions in abdominal pain and bloating postoperatively, with normalization of bowel function and increase in quality of life.

Conclusion

When severe lower abdominal pain and bloating in women who have had pelvic surgery are reproduced by colonoscopy, and there is an obvious kink in the bowel, sigmoid colectomy is worth considering.     

Prevalence and cumulative incidence of abnormal cervical cytology among HIV-infected Thai women: a 5.5-year retrospective cohort study

Background

Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings.

Methods

Retrospective chart review of patients with drug-susceptible tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001.

Results

Of 565 patients meeting eligibility criteria, 37 (6.6%) died during the study period. Of 37 deaths, 12 (32.4%) had tuberculosis listed as a contributing factor. In multivariate analysis controlling for follow-up time, four characteristics were independently associated with mortality: HIV co-infection (HR = 2.57, p = 0.02), older age at tuberculosis diagnosis (HR = 1.52 per 10 years, p = 0.001); initial sputum smear positive for acid fast bacilli (HR = 3.07, p = 0.004); and experiencing an interruption in tuberculosis therapy (HR = 3.15, p = 0.002). The association between treatment interruption and risk of death was due to non-adherence during the intensive phase of treatment (HR = 3.20, p = 0.001). The median duration of treatment interruption did not differ significantly in either intensive or continuation phases between those who died and survived (23 versus 18 days, and 37 versus 29 days, respectively). No deaths were directly attributed to adverse drug reactions.

Conclusions

In addition to advanced age, HIV and characteristics of advanced tuberculosis, experiencing an interruption in anti-tuberculosis therapy, primarily due to non-adherence, was also independently associated with increased risk of death. Improving adherence early during treatment for tuberculosis may both improve tuberculosis outcomes as well as decrease mortality.     

Clinical features of symptomatic uncomplicated diverticular disease: a multicenter Italian survey

Purpose

Clinical features of symptomatic uncomplicated diverticular disease are poorly investigated. Abdominal symptoms may be similar to those of irritable bowel syndrome. This survey aimed to assess clinical features associated with symptomatic uncomplicated diverticular disease.

Methods

This multicenter survey included consecutive outpatients with symptomatic uncomplicated diverticular disease to whom a detailed clinical questionnaire regarding demographic, lifestyle, and clinical features was administered. Diagnosis was based on the presence of diverticula and abdominal pain/discomfort. Irritable bowel syndrome and functional dyspepsia were assessed according to Rome III criteria.

Results

A total of 598 patients (50?% female, age 69?years), 71?% with newly diagnosed symptomatic uncomplicated diverticular disease and 29?% with history of colonic diverticula, were recruited. Diverticula were localized in the left colon in 78?% of the patients. Recurrent short-lived abdominal pain (<24?h) was present in 70?% (relieved by evacuation in 73?%), prolonged abdominal pain (>24?h) in 27?%, and recurrent abdominal bloating in 61?% of the patients. Normal, loose, or hard stools were reported by 58, 29, and 13?% of patients, respectively. Irritable bowel syndrome (IBS)-like and functional dyspepsia-like symptoms were recorded in 59 and 7?% of patients, respectively. IBS-like symptoms (odds ratio, 4.3) were associated in patients with prolonged abdominal pain.

Conclusions

Symptomatic uncomplicated diverticular disease is associated with a gender ratio of 1:1 and an unspecific clinical picture mainly characterized by normal stools, short-lived abdominal pain, abdominal bloating, IBS-like symptoms, while functional dyspepsia-like symptoms are not commonly present. These findings suggest that symptomatic uncomplicated diverticular disease often shows similar findings rather than overlaps IBS.     

Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study

Background

Intestinal fatty acid-binding protein (I-FABP) is a low-molecular-mass (15?kDa) cytosolic protein found exclusively in the epithelial cells of the small bowel mucosa. We aimed to evaluate the clinical usefulness of serum I-FABP measurement for the diagnosis of ischemic small bowel disease.

Methods

Patients with a clinical diagnosis of acute abdomen were recruited for this multicenter trial at one university hospital and nine city hospitals over a 13-month period. Serum I-FABP levels were measured in 361 eligible patients by an enzyme-linked immunosorbent assay using a specific monoclonal antibody.

Results

Of the 361 patients, 242 underwent surgery, and small bowel ischemia was diagnosed in 52 patients. The mean serum I-FABP level in the patients with small bowel ischemia was 40.7?±?117.9?ng/ml, which was significantly higher than that in patients with non-ischemic small bowel disease (5.8?±?15.6?ng/ml) and those with non-small bowel disease (1.8?±?1.7?ng/ml). The serum I-FABP cutoff level for the diagnosis of small bowel ischemia was 3.1?ng/ml. Serum I-FABP was more efficient than conventional biochemical markers, in terms of sensitivity and positive and negative predictive values, in the diagnosis of small bowel ischemia. However, its specificity was slightly lower than that of creatinine phosphokinase or lactate dehydrogenase. The positive and negative likelihood ratios of serum I-FABP were 3.01 and 0.29, respectively.

Conclusion

Serum I-FABP measurement is a non-invasive method that is potentially useful for the efficient identification of patients with acute abdomen who are at risk of small bowel ischemia.     

Significance of Serum and Ascitic Fluid C-Reactive Protein in Differential Diagnosis of Benign and Malignant Ascites

Background

The values of C-reactive protein (CRP) can prove useful in determining disease progress. Because of synthesis by the liver, production of CRP in response to inflammation may be attenuated in patients with liver dysfunction. This may result in differences interpreting CRP levels in patient with portal and non-portal hypertension ascites.

Aim

The aim of the present study is to assess discriminant value of serum and ascitic fluid CRP, which is easily accessible and inexpensive laboratory marker of inflammation, concentrations for diagnosis of underlying cause of ascites.

Methods

This prospective study was conducted at D?skap? Y?ld?r?m Beyaz?t Educational and Research Hospital Department of Gastroenterology. Patients with ascites were further divided into two subgroups based on underlying cause of ascites: Group 1, patient with ascites due to portal hypertensive etiology (high-gradient ascites); Group 2, patient with ascites due to non-portal hypertensive etiology (low-gradient ascites).

Results

A total of 91 patients fulfilling the criteria for a diagnosis of ascites were enrolled in the study. Of these patients, 50 had proven (Group 1) ascites due to portal hypertensive etiology (high-gradient ascites) and 41 had clinical (Group 2) ascites due to non-portal hypertensive etiology (low-gradient ascites). Mean baseline serum and ascites levels of CRP were significantly higher in Group 2 compared to those in Group 1 (p = 0.021, p = <0.0001, respectively).

Conclusions

Increased levels of serum and ascitic fluid CRP were associated with malignant ascites.     

Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum

BACKGROUND: Abdominal tuberculosis has varied presentation and can be confused with other conditions. METHODS: We report our experience with 46 patients. Charts of patients managed during 1984-97 were reviewed. RESULTS: Fifty-two percent were women and mean age was 46 years. Presenting symptoms were as follows: fever 70%; abdominal pain 70%; weight loss 68%; abdominal swelling 67%; change in bowel habit 39%; anorexia 30%; and sweating 30%. Common physical signs were as follows: fever 73%; ascites 61%; abdominal mass 13%; and doughy abdomen 9%. Thirty percent of patients either gave past history of TB or presented with active TB of other sites. TB skin test was positive in only 27% of patients. CT scans of abdomen were abnormal in 80%, showing ascites, peritoneal lesions or enlarged nodes. Ascitic fluid was diagnostic for TB on smear/culture in 33%. Peritoneal biopsy was performed by laparoscopy or laparotomy in 61%. It was positive for ganulomas in 97% and for smear/culture in 68%. Forty-two patients recovered after receiving anti-TB therapy for 9-12 months. Four patients died. One died within 1 month of initiation of therapy due to extensive TB, and death in the other 3 was due to unrelated causes. CONCLUSION: Abdominal TB should be suspected in patients with fever, abdominal pain and ascites. This condition carries good prognosis if promptly diagnosed and treated.     

Pulmonary manifestations in inflammatory bowel disease: a prospective study

Background

Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known.

Aim

To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD.

Methods

Ninety-five non-consecutive patients with IBD (12 Crohn’s disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status.

Results

Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p?Conclusion PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.     

Prise en charge des complications de la diverticulose colique de 1998 à 2010 à l’h?pital Habib Thameur de Tunis

Background

Diverticular disease is a rare entity. Acute diverticulitis is the most frequent clinical expression of diverticular disease. The presentation, investigations performed, and management are variable. The treatment may be medical, radiological or surgical. It??s conditioned by the severity of intra peritoneal infection and the general condition of patient.

Aim of study

The aim of this retrospective study was to analyze case reports of all the patients with complicated diverticular disease of the colon admitted in the same surgical center during a 13-year period and to describe epidemiological, clinical and therapeutic complications.

Patients and method

From 1998 to 2010, 30 patients were admitted for complicated diverticular disease in the department of surgery in the Habib Thameur Hospital.

Results

There were 14 men and 16 women. Mean age was 64 years (range: 44?C86). The mode of presentation was variable: acute diverticulitis (33%), lower gastrointestinal bleeding (23%), peritonitis (20%), occlusive syndrome (16%), colovesical fistulae (3%) and colouterine fistulae (3%). Fifteen patients were only treated medically and 15 patients were operated on, either as an emergency (n = 8) or electively (n = 7). The overall postoperative mortality rate was 3%.

Conclusion

Despite it increasing frequency, diverticular disease is an area little explored by clinical research. The evolution of this pathology is favorable if the medical or surgical treatment is instituted in time.     

The role of the Tokyo guidelines in the diagnosis of acute calculous cholecystitis

Background

Acute calculous cholecystitis is a condition in which the gallbladder becomes inflamed due to cholelithiasis. Early diagnosis reduces both mortality and morbidity. The aim of this retrospective study was to assess the diagnostic value of the Tokyo guidelines in patients with acute cholecystitis.

Methods

The medical records of patients admitted for acute calculous cholecystitis proven by pathological findings were collected between January 2007 and June 2008. Exclusion criteria included: acalculous cholecystitis, hepatobiliary malignancy, patients younger than 18 years and mortality unrelated to cholecystitis. A total of 235 patients were classified into three groups according to the severity grading in the Tokyo guidelines. Clinical characteristics among these patients were analyzed for comparison.

Results

Among all diagnostic criteria, right upper quarter (RUQ) abdominal pain (97.9%) and thickened gallbladder wall (92.3%) had the highest sensitivity rates, whereas pericholecystic fluid collection (18.3%) and RUQ abdominal mass (0.8%) had the lowest sensitivity rates. Higher sensitivity rates of diagnostic criteria were related to severe cholecystitis, except for Murphy’s sign and white blood cell (WBC) count. The presence of both RUQ abdominal pain and elevated C-reactive protein (55.1%), or both RUQ abdominal pain and elevated WBC count (53.7%), accounted for the highest sensitivity rates in making the definite diagnosis of acute cholecystitis. Seventeen patients (7.2%) without comparable typical image findings were prone to be afebrile and had normal C-reactive protein values compared to those with typical image findings.

Conclusion

Among all diagnostic criteria in the Tokyo guidelines for acute cholecystitis, RUQ abdominal pain and thickened gallbladder wall had the highest sensitivity rates, and RUQ abdominal mass had the lowest sensitivity rate. A combination of diagnostic criteria with different pathophysiologic findings, as noted in the Tokyo guidelines, can help clinicians make the correct diagnosis for patients with acute calculous cholecystitis.     

Helicobacter pylori infection and gastroduodenal diseases in Vietnam: a cross-sectional,hospital-based study

Background

There is very small occurrence of adenocarcinoma in the small bowel. We present a case of primary duodenal adenocarcinoma and discuss the findings of the case diagnostic modalities, current knowledge on the molecular biology behind small bowel neoplasms and treatment options.

Case

The patient had a history of iron deficiency anemia and occult bleeding with extensive workup consisting of upper endoscopy, colonoscopy, capsule endoscopy, upper gastrointestinal series with small bowel follow through and push enteroscopy. Due to persistent abdominal pain and iron deficiency anemia the patient underwent push enteroscopy which revealed adenocarcinoma of the duodenum. The patient underwent en-bloc duodenectomy which revealed T3N1M0 adenocarcinoma of the 4th portion of the duodenum.

Conclusions

Primary duodenal carcinoma, although rare should be considered in the differential diagnosis of occult gastrointestinal bleeding when evaluation of the lower and upper GI tract is unremarkable. We discuss the current evaluation and management of this small bowel neoplasm.     

La tuberculose péritonéale: étude rétrospective de 61 cas à l’hôpital Principal de Dakar

Aims

To describe the characteristic features (epidemiological, clinical, paraclinical, therapeutic and evolutive) of peritoneal tuberculosis in Senegal.

Patients and methods

Retrospective study, which included all cases of peritoneal tuberculosis identified at Principal hospital in Dakar between the 1 January 1996 and 30 June 2006.

Results

Sixty-one cases of peritoneal tuberculosis were included in ten years and six months. The mean age of patients was 36 years, and the sex ratio was 0.9. Ascites associated with fever was the most common symptom. The ascitic fluid was exudative in 92.4% and lymphocytic in 90.5%. Peritoneal tuberculosis was isolated in 70.5% of cases and associated with pleural effusion in 21%, lung involvement in 13% and liver involvement in 3.2%. The HIV was positive in 4.5% of patients who were tested. The definite diagnosis was based on laparoscopy associated with peritoneal biopsy showing granulomatous lesions in 70% of cases. The outcome was favourable in all cases after antituberculous therapy.

Conclusion

Peritoneal tuberculosis occurs in young adult with a discrete female predominance in this series. It must be suspected in the presence of any lymphocytic and exudative ascites associated with fever. The definite diagnosis is based on laparoscopy with peritoneal biopsy. The outcome is generally favourable with antituberculous treatment.     

Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience

Background

Abdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12?years in Southeastern Korea.

Methods

A total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB.

Results

The most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study.

Conclusions

Most patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.