Chahed Jamila, Mekki Mongi, Mansour Asma, Ben Brahim Mohamed, Maazoun Kais, Hidouri Saida, Krichene Imed, Sahnoun Lassâad, Jouini Riyadh, Belgith Mohsen, Zakhama Abdelfattah, Sfar Mohamed Tahar, Gueddiche Mohamed Neji, Harbi Abdelaziz, Amri Fethi, Mahfoudh Abdelmajid, Nouri Abdellatif
Paediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.
Pediatr Surg Int. 2010 Apr;26(4):413-8. doi: 10.1007/s00383-010-2555-z. Epub 2010 Feb 17.
Abdominal tuberculosis is one of the most frequent extra-pulmonary localizations. Its diagnosis is difficult and may lead to a delayed prescription of specific treatment. This study is aimed at stressing the role of laparoscopy associated with a biopsy in the diagnostic confirmation of abdominal tuberculosis particularly in doubtful cases.
The diagnostic features of 11 cases hospitalized for abdominal tuberculosis in the Paediatric Surgery Department of Fattouma Bourguiba Hospital in Monastir for a 6-year period (2001-2006), were evaluated retrospectively. The diagnosis of abdominal tuberculosis was substantiated histopathologically by laparoscopy in all cases. The epidemiological and clinical characteristics along with the laboratory, radiological and histological data were studied.
Eleven cases of abdominal tuberculosis with a mean age of 5.6 years were diagnosed. It was peritoneal tuberculosis in all cases and associated with intestinal localization in one case. A conversion to laparotomy was practiced in three patients: appendicular plastron in one case, pseudo-tumor aspect of an intestinal loop in another case and because of their pathological aspect appendicectomy and caecum biopsy in the third. The diagnosis was confirmed histologically by biopsies in nine cases and on excision pieces in the other two cases. All patients had an uneventful course with an antituberculosis treatment.
Abdominal tuberculosis is still frequent in Tunisia. Because of its non-specific clinical presentation and the limited means of investigation, a laparoscopy with biopsy should be practiced as first line diagnostic tool in case of doubtful abdominal tuberculosis. The earlier the diagnosis is established and an adapted antituberculosis treatment is started, the better the prognosis is.
腹部结核是肺外最常见的局部病变之一。其诊断困难，可能导致特异性治疗的延迟处方。本研究旨在强调腹腔镜检查联合活检在腹部结核诊断确诊中的作用，尤其是在可疑病例中。
回顾性评估在莫纳斯提尔法图玛·布尔吉巴医院小儿外科住院6年（2001 - 2006年）的11例腹部结核病例的诊断特征。所有病例均通过腹腔镜检查在组织病理学上证实为腹部结核。研究了流行病学和临床特征以及实验室、放射学和组织学数据。
诊断出11例腹部结核，平均年龄5.6岁。所有病例均为腹膜结核，其中1例伴有肠道病变。3例患者转为开腹手术：1例为阑尾包壳，另1例为肠袢假肿瘤样外观，第3例因病理表现行阑尾切除术和盲肠活检。9例通过活检组织学确诊，另外2例通过切除标本确诊。所有患者接受抗结核治疗后病情平稳。
腹部结核在突尼斯仍然常见。由于其临床表现不特异且检查手段有限，对于可疑的腹部结核病例，应将腹腔镜检查联合活检作为一线诊断工具。诊断确立越早并开始适当的抗结核治疗，预后越好。
