Balian A, de Pinieux I, Belloula D, Barthelemy P, Montembault S, Girard T, Raynard B, Le Gall C, Capron F, Naveau S, Chaput J C
Service d'Hépato-Gastroentérologie, Hôpital Antoine Béclère, Clamart.
Presse Med. 2000 May 20;29(18):994-6.
Extrapulmonary manifestations of tuberculosis are increasing in incidence. Abdominal tuberculosis may mimic a variety of gastrointestinal disorders. The diagnosis of abdominal tuberculosis is still difficult to establish before surgery.
We report 3 cases of abdominal tuberculosis in immunocompetent individuals. One patient presented with an ileocecal mass mimicking cancer. The second one presented with fever, ileocecal mass and ascites leading to the diagnosis of appendiceal peritonitis. The last patient was admitted for ascites, ovarian mass and high CA 125 serum level simulating ovarian cancer with peritoneal carcinomatosis.
In cases of abdominal tuberculosis when standard investigations are unhelpful, a PCR should be performed. Estimation of adenosine deaminase in ascitic fluid is an easy and reliable method for diagnosing tuberculous ascites. With these non invasive diagnostic procedures, surgery should be reserved only to patients with complications.
肺结核的肺外表现发病率正在上升。腹部结核可能类似多种胃肠道疾病。腹部结核在手术前仍难以确诊。
我们报告3例免疫功能正常个体的腹部结核病例。1例患者表现为回盲部肿块,类似癌症。第2例患者表现为发热、回盲部肿块和腹水,诊断为阑尾腹膜炎。最后1例患者因腹水、卵巢肿块和高血清CA 125水平入院,疑似卵巢癌伴腹膜转移。
在腹部结核病例中,当标准检查无帮助时,应进行聚合酶链反应(PCR)检测。腹水腺苷脱氨酶测定是诊断结核性腹水的一种简便可靠的方法。通过这些非侵入性诊断程序,手术应仅保留给有并发症的患者。