Muroni Mirko, Rouet Audrey, Brocheriou Isabelle, Houry Sidney
Department of General Surgery, Hospital Tenon, Paris, France,
J Gastrointest Surg. 2015 May;19(5):981-3. doi: 10.1007/s11605-015-2753-z. Epub 2015 Feb 4.
Abdominal tuberculosis is one of the most prevalent form of extra-pulmonary disease, and the diagnosis is difficult because of non-specific clinical features.
We presented a case of a Tunisian woman with cough, nausea, decreased appetite and pelvic-abdominal pain. CT scan showed peritoneal thickening, peritoneal tiny nodules and enlarged mesenteric lymph nodes ascitic fluid. Sputum analysis was negative. Abdominal paracentesis was performed, and no malignant cell was detected. The Ziehl staining revealed a negativity for acid-fast bacilli.
Diagnostic laparoscopy was performed. Biopsy specimens of peritoneum, liver, omentum and diaphragm showed omental epithelioid granulomas with a centrale caseous necrosis and Langhans giant cells. The patient received anti-tubercular treatment.
In case of suspicion of tuberculosis, when bacteriologic and cytologic analysis is negative, laparoscopy with biopsies is helpful for correct diagnosis and appropriate management.
腹部结核是肺外疾病最常见的形式之一，因其临床特征不具特异性，诊断困难。
我们报告了一例突尼斯女性病例，该患者有咳嗽、恶心、食欲减退及盆腔-腹部疼痛。CT扫描显示腹膜增厚、腹膜小结节及肠系膜淋巴结肿大并有腹水。痰液分析为阴性。进行了腹腔穿刺，未检测到恶性细胞。齐-尼氏染色显示抗酸杆菌阴性。
进行了诊断性腹腔镜检查。腹膜、肝脏、网膜和膈肌的活检标本显示网膜上皮样肉芽肿，伴有中央干酪样坏死和朗汉斯巨细胞。患者接受了抗结核治疗。
在怀疑结核病的情况下，当细菌学和细胞学分析为阴性时，腹腔镜活检有助于正确诊断和适当治疗。
