Nafeh M A, Medhat A, Abdul-Hameed A G, Ahmad Y A, Rashwan N M, Strickland G T
Department of Tropical Medicine, Assiut University Faculty of Medicine, Egypt.
Am J Trop Med Hyg. 1992 Oct;47(4):470-7. doi: 10.4269/ajtmh.1992.47.470.
Abdominal laparoscopy was performed on 200 patients with undiagnosed ascites. It was unsuccessful in one patient with tuberculous peritonitis because of extensive adhesions. A presumptive diagnosis of tuberculous peritonitis based on clinical findings and peritoneal tubercles or adhesions visualized during laparoscopy was made in 90 of these patients. The diagnosis was confirmed in 88 by histopathology, bacteriology, or therapeutic response. Two of the 109 remaining patients who had other presumptive diagnoses made during laparoscopy were eventually confirmed to be cases of tuberculous peritonitis. Of 91 patients with tuberculous peritonitis included in this series, 79% were females, with the majority (79%) of them being of child-bearing age. Half had been ill for longer than one month. The most frequent complaints were abdominal pain, fever, anorexia, night sweats, abdominal swelling, and weight loss. Ascites, fever, wasting, pallor, and abdominal tenderness were common findings. Ultrasonography demonstrated ascites in all patients who underwent this procedure; 21% also had adhesions. Pleural effusion was present in 15% and pulmonary tuberculosis was detected in only two patients. Biopsy samples taken during laparoscopy showed that 60% had noncaseous granulomas and 33% had caseous granulomas. Mycobacterium tuberculosis was detected in 77%, with guinea pig inoculation having the highest sensitivity, followed by culture, and lastly by acid-fast smear. Mycobacterium tuberculosis was isolated more easily from biopsy samples than from ascitic fluid. Nine of 20 M. tuberculosis isolates that were identified as to species were M. bovis. Tuberculous peritonitis, a frequent cause of febrile ascites in Egyptian women, was easily diagnosed by histopathologic and bacteriologic studies of biopsy samples taken at laparoscopy. All patients responded rapidly to antituberculosis therapy.
对200例不明原因腹水患者进行了腹部腹腔镜检查。其中1例结核性腹膜炎患者因广泛粘连，腹腔镜检查未成功。根据临床表现以及腹腔镜检查时所见的腹膜结节或粘连，对其中90例患者作出了结核性腹膜炎的初步诊断。经组织病理学、细菌学检查或治疗反应，88例确诊。其余109例在腹腔镜检查时有其他初步诊断，其中2例最终确诊为结核性腹膜炎。本系列纳入的91例结核性腹膜炎患者中，79%为女性，大多数（79%）处于育龄期。半数患者患病时间超过1个月。最常见的症状为腹痛、发热、厌食、盗汗、腹部膨隆和体重减轻。腹水、发热、消瘦、面色苍白和腹部压痛为常见体征。超声检查显示，所有接受该检查的患者均有腹水；21%的患者还有粘连。15%的患者有胸腔积液，仅2例患者检测出肺结核。腹腔镜检查时采集的活检样本显示，60%有非干酪样肉芽肿，33%有干酪样肉芽肿。77%的患者检测出结核分枝杆菌，豚鼠接种的灵敏度最高，其次是培养，最后是抗酸涂片。从活检样本中分离结核分枝杆菌比从腹水中更容易。在已鉴定出种属的20株结核分枝杆菌分离株中，9株为牛分枝杆菌。结核性腹膜炎是埃及女性发热性腹水的常见病因，通过对腹腔镜检查时采集的活检样本进行组织病理学和细菌学研究可轻易诊断。所有患者对抗结核治疗反应迅速。
